Delaying Bacillus Calmette-Guerin (BCG) Vaccine in HIV-Exposed Infants: A Systematic Review and Meta-Analysis

Background: Infants who have been exposed to the human immunodeficiency virus (HIV) are at a higher risk of contracting Mycobacterium tuberculosis, have a higher chance of developing tuberculosis (TB), and are more likely to experience bacillus Calmette-Guerin (BCG)-related side effects. The only antituberculosis (TB) vaccine now available is Bacillus Calmette Gu?rin (BCG). We assessed when BCG may be given to an HIV-exposed uninfected (HEU) infant without exposing the child to HIV or tuberculosis. Objective: To establish the best time for administering BCG vaccination to HIV-exposed infants and to evaluate the impact of administering BCG vaccine at birth vs delaying BCG vaccine at delivery. Methods: We searched in studies related to the subject in different databases: Web of Science, LILACS, CENTRAL (Cochrane Central Register of Controlled Trials), PubMed and CINAHL, Scopus, as well as conference abstracts from the HIV/AIDS website, then we conducted a systematic review and Meta-analysis. Results: CD4+ T cells activation after 14 weeks comparing BCG delayed to BCG given at birth in HIV-exposed infants, the random-effects meta-analysis of CD4+ T cells activation (14 weeks) yielded a pooled MD estimate of -3.58 (95% CI -6.73 to -0.43, P=0.03) with I2= 97%. Conclusion: In HIV-exposed uninfected (HEU) infant, BCG vaccination causes immunological alterations, and the intensification in the percentage of activated CCR5+CD4+ HIV target cells. Therefore, delaying BCG vaccine would be advantageous to HEU rather than giving it shortly after the delivery, but more evidenceis still need to while exploring this new paradigm.