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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: METHODS, OBJECTIVE, METHODS, RESULTS. Meshes: Anti-HIV Agents, BCG Vaccine, CD4 Lymphocyte Count, Female, Follow-Up Studies, HIV Infections, HIV-1, Humans, Immune Reconstitution Inflammatory Syndrome, Infant, Lymphadenitis, Male, Prospective Studies, RNA, Viral, Risk Factors, South Africa, Time Factors.
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Does early antiretroviral treatment reduce risk of bacille Calmette-Guérin immune reconstitution adenitis? Context: Two centres in Soweto and Cape Town, South Africa. To assess the effects of timing of initiation of antiretroviral treatment (ART) and other factors on the risk of bacille Calmette-Guérin (BCG) related regional adenitis due to immune reconstitution inflammatory  syndrome (BCG-IRIS) in human immunodeficiency virus (HIV) infected infants. HIV-infected infants aged 6-12 weeks with CD4 count ≥25% enrolled in the Children with HIV Early Antiretroviral Therapy (CHER) Trial received early (before 12 weeks) or deferred (after immunological  or clinical progression) ART; infants with CD4 count <25% all received early ART. All received BCG vaccination after birth. Reactogenicity to BCG was assessed prospectively during routine study follow-up. Of 369 infants, 32 (8.7%) developed BCG-IRIS within 6 months of starting  ART, 28 (88%) within 2 months after ART initiation. Of the 32 cases, 30 (93.8%) had HIV-1 RNA > 750 000 copies/ml at initiation. Incidence of BCG-IRIS was 10.9 and 54.3 per 100 person-years (py) among infants with CD4 count ≥25% at enrolment receiving early (at median age 7.4  weeks) vs. deferred (23.2 weeks) ART, respectively (HR 0.24, 95%CI 0.11-0.53, P < 0.001). Infants with CD4 count <25% receiving early ART had intermediate incidence (41.7/100 py). Low CD4 counts and high HIV-1 RNA at initiation were the strongest independent risk factors  for BCG-IRIS.
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Early ART initiation before immunological and/or clinical progression substantially reduces the risk of BCG-IRIS regional adenitis. Final Decision: yes