Interactions of the human immunodeficiency virus and tuberculosis and the implications for BCG vaccination

AIDS has become a global epidemic, with greater than 100,000 cases officially reported in 140 countries and an estimated 5-10 million asymptomatic carriers of the human immunodeficiency virus (HIV), the etiologic agent of AIDS. With an increase in HIV infection in some developing countries, there has been a resurgence in tuberculosis, and concern has been raised about the indications, efficacy, and safety of bacille Calmette-Guérin (BCG) vaccination. Anecdotal reports of local reactions and disseminated disease have been described in HIV-infected children and adults. Ten HIV-infected infants, who received BCG vaccination within 2 months of birth, developed local lymphadenitis at 4-15 months. However, in one preliminary survey in Zaire, the rates of local lymphadenitis were equal in HIV-infected and HIV-uninfected children, and no dissemination has been observed to date. Until further information is known, BCG vaccinations should not be given to symptomatic HIV-infected individuals and should only be given to HIV-infected children who are asymptomatic and who reside in areas where tuberculosis is highly endemic and where the risk of tuberculosis may outweigh the potential complications of BCG immunization.