17th International AIDS Conference Mexico City, Mexico - August 13 - 18, 2008

CASE SERIES OF HIV-INFECTED CHILDREN WITH BACILLUS CALMETTE-GUÉRIN VACCINE RELATED LYMPHADENOPATHY IN LILONGWE, MALAWI

Int Conf AIDS. 2008 Aug 13-18;17 Abstract No. MOAB0303

J. Midturi ¹, P. Kazembe², G. Schutze³, M. Kline^3
1Baylor College of Medicine Clinical Center of Excellence, Pediatric AIDS Corps, Lilongwe, Malawi, ²Baylor College of Medicine Clinical Centre of Excellence, LIlongwe, Malawi, ³Baylor International Pediatric AIDS Initiative, Baylor College of Medicine, Houston, United States

BACKGROUND: There is paucity of literature on Bacillus Calmette-Guérin (BCG) vaccine in HIV-infected children. Malawian children routinely receive BCG vaccine at birth.

METHODS: This was a retrospective chart review of all HIV-infected children registered at Baylor College of Medicine Clinical Center of Excellence-Malawi from July 2005 to February 2007. Using an electronic medical record (EMR) we identified children with a diagnosis of axillary lymphadenopathy, axillary lymphadenitis, BCG reaction, TB lymphadenitis, or right axillary adenopathy. Identified charts were reviewed to verify the diagnosis of BCG disease immune reconstitution inflammatory syndrome (IRIS), obtain basic demographic data, determine onset of disease after antiretroviral therapy (ART) initiated, disease course and classification.

RESULTS: Prevalence of BCG disease IRIS in our study population was 13/958 (1.46%). Medians for age, baseline CD4%, and follow-up CD4% were 9 months (range: 4- 18), 13% (range: 2.2%- 23.4%), and 23.5% (range: 13%- 31%), respectively. Median time to onset of BCG disease IRIS was 3.5 weeks (range: 1- 5.5), and median time to resolution of disease was 3 months (range: 1- 4). The median follow up time was 20 weeks (range: 2-37). The mortality rate was 3.2 per 100 person weeks. Anti-tuberculosis therapy was initiated in 8 patients, but 6 had anti-tuberculosis therapy prior to development of BCG disease IRIS. Antimicrobials were used in 6 patients, and none required surgical intervention. Spontaneous rupture of the affected lymph node occurred in 9/13(69%) patients.

CONCLUSIONS: This study reveals potential development of an adverse effect of BCG vaccination in HIV-infected infants. There is a risk of mortality associated with HIV infection and BCG disease. The majority of cases of BCG disease following the administration of ART are most likely due to IRIS. Our description of the clinical course of BCG disease IRIS in an immune-suppressed pediatric population highlights complexities in clinical management of HIV-infected children.

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2008-08-13
MOAB0303

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