title: The risks and benefits of childhood bacille Calmette-Guérin immunization among adults with AIDS. International MAC study groups.
abstract: OBJECTIVE
  To define the risks of disseminated bacille Calmette-Guérin (BCG) or disseminated Mycobacterium tuberculosis in adults with AIDS who were immunized with BCG in childhood.
  
  
  METHODS
  HIV-infected patients with CD4 < 200 x 10(6)/l were enrolled from five study sites (New Hampshire, Boston, Finland, Trinidad and Kenya). Prior BCG immunization was determined and blood cultures for mycobacteria were obtained at study entry and at 6 months. Acid-fast bacilli were identified as Mycobacterium tuberculosis complex (MTBC) using DNA probes. MTBC isolates were then typed by both IS6110 restriction fragment length polymorphism and polymerase chain reaction/restriction enzyme analysis.
  
  
  METHODS
  Most patients in New Hampshire and Finland were outpatients; most patients in Trinidad were inpatients with terminal illness; and most patients in Kenya were outpatients, although 44 were inpatients with terminal illness.
  
  
  METHODS
  A total of 566 patients were enrolled, including 155 with childhood BCG immunization; 318 patients had a single study visit and culture, and 248 patients had two study visits and cultures.
  
  
  METHODS
  Isolation and identification of mycobacteria from blood cultures.
  
  
  RESULTS
  Blood cultures were positive for MTBC in 21 patients; none were positive for M. bovis BCG, and 21 were M. tuberculosis-positive. In Trinidad, seven (87%) out of eight isolates of M. tuberculosis were indistinguishable by IS6110 typing; BCG immunization was associated with a decreased risk of bacteremic infection with M. tuberculosis (P = 0.05).
  
  
  CONCLUSIONS
  The risk of disseminated BCG among adult AIDS patients with childhood BCG immunization is very low. Childhood BCG immunization is associated with protection against bacteremia with M. tuberculosis among adults with advanced AIDS in Trinidad.
authors.affiliation: Infectious Disease Section, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Marsh
authors.forename: C F
authors.initials: CF
authors.lastname: von Reyn
authors.forename: J
authors.initials: J
authors.lastname: Edwards
authors.forename: M A
authors.initials: MA
authors.lastname: Ristola
authors.forename: C
authors.initials: C
authors.lastname: Bartholomew
authors.forename: R J
authors.initials: RJ
authors.lastname: Brindle
authors.forename: C F
authors.initials: CF
authors.lastname: Gilks
authors.forename: R
authors.initials: R
authors.lastname: Waddell
authors.forename: A N
authors.initials: AN
authors.lastname: Tosteson
authors.forename: R
authors.initials: R
authors.lastname: Pelz
authors.forename: C H
authors.initials: CH
authors.lastname: Sox
authors.forename: R
authors.initials: R
authors.lastname: Frothingham
authors.forename: R D
authors.initials: RD
authors.lastname: Arbeit
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000517:prevention & control; D000328:Adult; D002675:Child, Preschool; D006801:Humans; D007114:Immunization; D007156:Immunologic Memory; D007223:Infant; D009169:Mycobacterium tuberculosis / Q000276:immunology*; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control