title: Immunogenicity of BCG in HIV-exposed and non-exposed infants following routine birth or delayed vaccination.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) exposed infants are at high risk of Mycobacterium tuberculosis exposure, have high rates of progression to tuberculosis (TB) disease and are at significant risk of bacille Calmette-Guérin (BCG) induced adverse events.
  
  
  OBJECTIVE
  To evaluate a delayed BCG vaccination strategy in HIV-exposed infants.
  
  
  METHODS
  A randomised trial of routine BCG vaccination given at birth compared to 14 weeks of age in HIV-exposed non-infected and non-HIV-exposed infants to investigate longitudinal BCG-induced immune responses using a 7-day whole blood interferon-gamma (IFN-γ) enzyme-linked immunosorbent assay.
  
  
  RESULTS
  A significantly higher proportion of infants had positive responses to M. tuberculosis purified protein derivative (PPD) and BCG at 14 weeks in the birth vs. delayed vaccination groups (P = 0.001 for both). This difference was no longer apparent at weeks 24 or 52. Among infants vaccinated at birth, the 14-week IFN-γ response to M. tuberculosis PPD was lower among HIV-exposed than non-exposed infants (276.5 pg/ml vs. 790.2, P = 0.048). Among all infants, there were significant correlations between the magnitude of IFN-γ responses to BCG, M. tuberculosis PPD, TB 10.4 and culture filtrate protein 10/early secreted antigenic target 6.
  
  
  CONCLUSIONS
  The timing of vaccination had limited effect on BCG-induced IFN-γ responses, which waned considerably over 1 year despite initial vigorous responses in both vaccination groups. The lower responses in HIV-exposed non-infected infants suggest potentially altered mycobacterial immunity early in life.
authors: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors: A C
authors: AC
authors: Hesseling
authors: Division of Immunology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town Health Sciences Faculty, Cape Town, South Africa; Seattle Children's Research Institute, Seattle, Washington, USA.
authors: H B
authors: HB
authors: Jaspan
authors: Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research/Medical Research Council Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors: G F
authors: GF
authors: Black
authors: Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research/Medical Research Council Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors: N
authors: N
authors: Nene
authors: Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research/Medical Research Council Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors: G
authors: G
authors: Walzl
mesh_terms: D000917:Antibody Formation / Q000276:immunology; D001500:BCG Vaccine / Q000627:therapeutic use*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D007223:Infant; D007371:Interferon-gamma / Q000097:blood*; D008297:Male; D014376:Tuberculosis / Q000517:prevention & control*; D014611:Vaccination
chemical_list: D001500:BCG Vaccine; D007371:Interferon-gamma