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Safety of BCG for treatment of superficial bladder cancer
Dec 1, 2013

Hi. My name is Edgardo Bottaro. I work with HIV-infected patients in Buenos Aires, Argentina. Recently I received an HIV-infected patient with superficial bladder cancer. He is under HAART, with a suppressed VL and a CD4 count >700 cells/mm3. The urologist asked my opinion about instillation with BCG for treatment of his tumor. I was surprised!! I have not experience with that therapy. After reading, I learned about side effects in HIV-uninfected people; the literature involving HIV-infected patients is scarce. I think (... the urologist thinks...) BCG is the best option, do you think isoniazide prophylaxis may be useful for reducing the chance of sistemic side effects? Would you use isoniazide in this situation? Thank you for your answer. Edgardo

Response from Dr. Young

Hello Dr. Bottaro and thanks for your post and interesting question.

Since your patient is on ART and has an undetectable and normal CD4 count, I'd imagine that his risks of disseminated BCG infection would be relatively low. INH treatment probably would be contraindicated during the time around the cancer treatment, but I'd wonder if there would be any downside for INH preventive treatment afterwards.

Please let us know what the decision is. BY

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