RESUMO
SETTING: Two centres in Soweto and Cape Town, South Africa. OBJECTIVE: 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. DESIGN: 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. RESULTS: 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. CONCLUSIONS: Early ART initiation before immunological and/or clinical progression substantially reduces the risk of BCG-IRIS regional adenitis.
Assuntos
Fármacos Anti-HIV/farmacologia , Vacina BCG/efeitos adversos , Infecções por HIV/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , Fármacos Anti-HIV/administração & dosagem , Vacina BCG/uso terapêutico , Contagem de Linfócito CD4 , Feminino , Seguimentos , HIV-1/genética , Humanos , Síndrome Inflamatória da Reconstituição Imune/prevenção & controle , Lactente , Linfadenite/induzido quimicamente , Linfadenite/prevenção & controle , Masculino , Estudos Prospectivos , RNA Viral , Fatores de Risco , África do Sul , Fatores de TempoAssuntos
Transmissão de Doença Infecciosa , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , HIV-1 , África , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Anticorpos Anti-HIV/sangue , Infecções por HIV/virologia , HIV-1/genética , HIV-1/imunologia , Humanos , Lactente , Masculino , Núcleo Familiar , Filogenia , RNA Viral/análise , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
In the surgical management of congenital pes valgus, vertical talus is the hardiest deformity to be reduced. By opening the lower tibio-fibular joint, associated with classic capsulotomies and tendons-lengthening, the authors have reduced vertical talus easily in three feet, for two children. One of them had a myopathy (central core disease), the other had a muscular hypotonia by cerebral palsy. Morphological results are good, but the function remains fair, due to the muscular weakness, that is usual in these lesions.
