Heinsbroek Ellen, Tafatatha Terence, Phiri Amos, Ngwira Bagrey, Crampin Amelia C, Read Jonathan M, French Neil
aDepartment of Clinical Infection, Microbiology, Institute of Infection and Global Health, University of Liverpool, UK bKaronga Prevention Study, Chilumba cThe Polytechnic, University of Malawi, Blantyre, Malawi dDepartment of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London eDepartment of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, UK.
AIDS. 2015 Sep 10;29(14):1837-44. doi: 10.1097/QAD.0000000000000755.
HIV-infected adults have high rates of pneumococcal carriage and invasive disease. We investigated the effect of antiretroviral therapy (ART) on pneumococcal carriage in HIV-infected adults prior to infant pneumococcal conjugate vaccine (PCV) rollout.
Observational cohort study.
We recruited HIV-infected adults newly attending a rural HIV clinic in northern Malawi between 2008 and 2010. Nasopharyngeal samples were taken at baseline and after 6, 12, 18 and 24 months. We compared pneumococcal carriage by ART status using generalized estimated equation models adjusted for CD4 cell count, sex, seasonality, and other potential confounders.
In total, 336 individuals were included, of which 223 individuals started ART during follow-up. Individuals receiving ART had higher pneumococcal carriage than individuals not receiving ART (25.9 vs. 19.8%, P = 0.03) particularly for serotypes not included in PCV13 (16.1 vs. 9.6% P = 0.003). Following adjustment, increased carriage of non-PCV13 serotypes was still observed for individuals on ART, but results for all serotypes were nonsignificant [all serotypes: adjusted risk ratio (aRR) 1.22 (0.95-1.56); non-PCV13 serotypes: aRR 1.72, 95% CI 1.13-2.62].
Pneumococcal carriage in HIV-infected adults in Malawi remained high despite use of ART, consistent with failure of mucosal immune reconstitution in the upper respiratory tract. There was evidence of increased carriage of non-PCV13 serotypes. HIV-infected adults on ART could remain an important reservoir for pneumococcal diversity post infant pneumococcal vaccine introduction. Control of pneumococcal disease in African HIV remains a priority.
感染艾滋病毒的成年人肺炎球菌携带率和侵袭性疾病发生率较高。我们在婴儿肺炎球菌结合疫苗（PCV）推广之前，调查了抗逆转录病毒疗法（ART）对感染艾滋病毒的成年人肺炎球菌携带情况的影响。
观察性队列研究。
我们招募了2008年至2010年间新到马拉维北部一家农村艾滋病毒诊所就诊的感染艾滋病毒的成年人。在基线以及6、12、18和24个月后采集鼻咽样本。我们使用广义估计方程模型，对CD4细胞计数、性别、季节性和其他潜在混杂因素进行调整，比较了按ART状态划分的肺炎球菌携带情况。
总共纳入了336人，其中223人在随访期间开始接受ART治疗。接受ART治疗的个体肺炎球菌携带率高于未接受ART治疗的个体（25.9%对19.8%，P = 0.03），特别是对于PCV13未包含的血清型（16.1%对9.6%，P = 0.003）。调整后，仍观察到接受ART治疗的个体非PCV13血清型携带率增加，但所有血清型的结果均无统计学意义[所有血清型：调整风险比（aRR）1.22（0.95 - 1.56）；非PCV13血清型：aRR 1.72，95%可信区间1.13 - 2.62]。
尽管使用了ART治疗，马拉维感染艾滋病毒的成年人肺炎球菌携带率仍然很高，这与上呼吸道黏膜免疫重建失败一致。有证据表明非PCV13血清型的携带率增加。在引入婴儿肺炎球菌疫苗后，接受ART治疗的感染艾滋病毒的成年人可能仍然是肺炎球菌多样性的重要储存宿主。控制非洲艾滋病毒感染者的肺炎球菌疾病仍然是一个优先事项。
