immunologic efficiency and safety of bacterination BTSZH of children born from sick HIV-infections of women

Condition of postvaccinal BTSZH-IMMUNITY and safety vaktsinayotsii BTSZH it is studied at 376 children. From them:

- Children with the established diagnosis of a HIV-infection - 131 persons (В23);

- Children with perinatalnym contact on a HIV-infection - 141 persons (R - 75);

- Children born by women from a HIV-negative by the status - 104 cheyoloveka (comparison group - GS).

Terms of bacterination of children were various and varied from neskolyokih days (in a maternity home) till several years (table 7.14).

As a whole from 376 children in the conditions of a maternity home have been inoculated BTSZH 37,5 % of children, about 18 months - 43,4 %, 18-24 months - 2,9 % and staryoshe 24 months (2th years) - 15,9 % of children are elderly.

Table 7.14

Terms of bacterination BTSZH of children of various groups

Groups of children In total children Terms of bacterination БЦЖ*
In a sort.

The house

To 18 months 18-24 months > 2лет
abs. abs. % abs. % abs. % abs. %
В23 131 37 28,2 25 19,1 9 6,9 60 45,8
R-75 141 10 7,1 128 90,8 3 2,1 - -
GS 104 94 90,4 10 9,6 - - - -
Total 376 141 37,5 163 43,4 11 2,9 60 15,9

*Примечание: terms are chosen taking into account children born from women with a HIV-infection, BTSZH officially allowed to enter after putting off diagnoyoza a HIV-infection in 18 months

In a maternity home all children of group sravneyonija (90,4 %) have been inoculated practically, that corresponds to data of other researches [4,29].

Small percent of children inoculated in a maternity home of group V23 and R-75 as children who were casually priviyoty BTSZH for 3-7 day of a life in the absence of data of a HIV-status at mother of the child have entered into research. Children with a HIV-infection in later terms inoculated tselenayopravlenno (the analysis in this group will be spent more low).

Proceeding from anamnesis data clinical implications on introduction vakyotsiny BTSZH in the form of symptoms of an intoxication, a fervescence have not been noted in one group. Presence of postvaccinal immunity estimated in a year when the scar is completely generated and for the first time reyobenku spend tuberkulinovuju assay for reaction revealing giperchuvstyovitelnosti the slowed down type.

The postvaccinal sign (the scar in the size of 3 and more mm was defined at 72,3 % of children) in a place of introduction BTSZH was registered practically at all deyotej in all groups; in comparison group - in 83 % of cases, in group R-75 - 77,5 % and in group V23 - in 76,9 % of cases (a difference statistically not dostoveryona, p> 0,05) (fig. 7.6).

Fig. 7.6. The characteristic of the immune answer to introduction BTSZH at children

Investigated groups (%)

Results tuberkulinovyh assays considerably differed at children,

Sick HIV-infections and children, without a HIV-infection (fig. 7.6).

Results tuberkulinovoj Mantoux reactions with 2ТЕ PPD-L at children, priyovityh BTSZH with perinatalnym contact on a HIV-infection (R75) without realiyozatsii a HIV-infection in the subsequent, practically did not differ from takoyovyh at healthy children (GS): positive reaction is noted in 71 % of cases (80 % in GS; p> 0,05). At children with a HIV-infection positive reaction to a Mantoux reaction with 2ТЕ was registered only at 3 children from 10 vaktsinirovanyonyh (29,7 %), it in 2,7 is more rare, than in group of comparison and in 2,4 times - in group R75 (ОШ=0,15; Dee 0,10-0,77).

Thus the analysis of efficiency of spent bacterination BTSZH (estimated on scar presence as a local component on spetsificheyosky a stimulus and to occurrence of positive reaction to a tuberculin - hypersensitivities of the slowed down type (GZT) as link immune otveyota on introduction of live micobacteria of the vaccine strain) allows utveryozhdat, that a HIV-status of mother - in the absence of a becoming infected of the child (R - 75) - does not render immunnosupressivnogo influences on postnatalnoe razviyotie immune system, and such children on the clinico-immunologic reactions to bacterination BTSZH do not differ from healthy children (GS). At the same time, despite ability V-limfotsitov to produce an antibody (at 30 % reaction to tuberculin introduction positive), probably, in connection with suppression helpernoj functions T-limfotsitov СD4 +, children from a HIV - an infection are not capable of formation of the specific immune answer at the same level, as children without a HIV-infection (GS and R-75). Scar formation occurs at the expense of inflammatory changes in a skin, bound to introduction of intradermally suspension of live culture of micobacteria (the vaccine strain), and its presence cannot serve as criterion of efficiency vaktsiyonatsii at children with a HIV-infection.

The analysis of results of bacterination BTSZH at children with a HIV-infection, vaccinated in various terms and under various conditions.

The analysis of efficiency of bacterination by a vaccine of BTSZH TH at children with the established diagnosis of a HIV-infection and vaccinated in the various is carried out

Age terms. It were children from children's home of of St.-Petersburg (18 persons), inoculated in 2002-2005гг. (Conditionally group) and children, nabljudavshieyosja in the Center AIDS of of Moscow (60 persons), inoculated in 2008-2013гг. (Conditionally group). All children have been inoculated after preliminary statement proyoby Mantu with 2ТЕ PPD-L with negative result. The characteristic of these children on some parametres is presented in the table more low (table 7.15)

Table 7.15

The characteristic of children with a HIV-infection, inoculated BTSZH

Parametres Group "And" n=18 Group "" n=60
Floor 14 (77,8 %) 28 (46,7 %)
M floor 4 (22,2 %) 32 (53,3 %)
Compare age of an establishment of a statusavich-infection 6,82,9 month 7,33,8 month
Compare age of bacterination BTSZH 18,45,7 month 7,71,5 years
Received art 6 (33,3 %) 60 (100 %)
Compare age of appointment art 23,84,2 month 3,42,0 years
Compare value CD4 + (kl/mkl, %) * 1483484;> 25 % 913,25131,10;> 25 %

* The note: the absolute number of cells depends on age: the the child - the more cells is more younger; normal value for the child from 5 years - not less than 700 cells.

The HIV-infection diagnosis has been established on the average aged 6 8месяцев. All children are inoculated against the normal immune status (izyovestno, that relative maintenance CD4+лимфоцитов at children be exposed to smaller fluctuations, than their absolute number which depends from obshcheyogo quantities of lymphocytes, various at children till 5 years). One child did not have a depression of relative and absolute quantity CD4 + less than 25 % of age norm. Considering various age of children in group "And", HIV-infection stages have been defined as А1, В1 without immunosupresyosii and in group "" - a stage 3 (28 persons) and 4A-remission (32 persons). ViYOrusnaja the load (quantitative definition RNK a HIV) at children before vakyotsinatsiej was not defined (was below a threshold of sensitivity of the test). Time
lichalsja age of children in which they have been inoculated: in group "And" children have been vaccinated at early age (middle age has made 1,5 years), in group "" - from 4 till 11 years, middle age has made 7,7 yo 1,5 years. Except toyogo, all children of group "" have been vaccinated against spent art in teyochenie several years (3,4 yo 2,0) whereas in group "And" - art received 6 deyotej, and 4 of them already after carrying out of bacterination BTSZH.

The characteristic of a condition of postvaccinal immunity at children of these groups (by the same criteria - a scar and positive reaction to a Mantoux reaction with 2 THOSE) is presented in table 7.16.

Table 7.16

The characteristic of postvaccinal immunity at children in group "And" and group ""

Groups of children The characteristic of postvaccinal immunity
Scar Reaction to a Mantoux reaction with 2ТЕ
The positive The doubtful The negative
"AND" n=18 15 (83,3 %) 7 (38,9 %) - 11 (61,1 %)
"@" n=60 55 (91,7 %) - 12 (20 %) 68 (80 %)

The current of the postvaccinal period was smooth at all vaccinated children (under the anamnesis). Differences in groups on frequency of formation of a scar in a place of introduction BTSZH was not (83,3 % and 91,7 %). Reaction to a Mantoux reaction with 2 THOSE essentially differed: in group "And" positive reaction to a tuberculin in a year is taped at 38,9 % of vaccinated children, sensitivity to tuyoberkulinu was moderated: the average size of a papule (in diameter) made 6,30,7 mm. In group "" there were no positive reactions, doubtful reactions (a papule from 2 to 4 mm) were defined at 20 % of children.

Thus, at children with a HIV-infection, inoculated BTSZH is elderly till 2th years (18,4 yo 5,7 months) specific immunity was generated at treyoti, though also not so strained, judging by sensitivity to a tuberculin. Practically the immune answer at children inoculated in more was not formed

232 advanced age (7,7 yo 1,5 years) against spent art: doubtful assays, especially in the size 2 mm (are noted at 9 children from 12), are possible rastseniyovat as "ukolochnuju" or nonspecific reaction to introduction tuberkuyolina.

Probably, art which it is long children in group "" before bacterination received and did not interrupt it after bacterination, plays a positive role not only in depression of risk of development of a generalised BTSZH-INFECTION at children of early age [177], but also interferes with development of the high-grade immune answer on BTSZH.

Influence of vaccine BTSZH on a current of a HIV-infection at children not vyjavleyono. Dynamics of indicators CD4 + - T-limfotsitov and a virus load in techeyonie has not taped 3-6 months differences before bacterination BTSZH: the virus load was below a threshold of sensitivity of the test in all cases; level of specific CD4-cells corresponded to age physiological norm, as in про

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Scientific source KLEVNO HOPE IVANOVNA. TUBERCULOSIS At CHILDREN, SICK HIV-INFECTIONS (prevalence, features of clinical implications, diagnostics, treatment, preventive maintenance). The dissertation on competition of a scientific degree of the doctor of medical sciences. Moscow - 2015. 2015

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