Weinberg Adriana, Mussi-Pinhata Marisa M, Yu Qilu, Cohen Rachel A, Almeida Volia C, Amaral Fabiana, Pinto Jorge, Teixeira Maria L B, Succi Regina C M, Freimanis Laura, Read Jennifer S, Siberry George
aAnschutz Medical Center, University of Colorado Denver, Aurora, Colorado, USA bDepartment of Pediatrics, Ribeirão Preto School of Medicine, University of São Paulo, Sao Paulo, Brazil cWestat, Rockville, Maryland, USA dDepartamento de Medicina da Universidade Federal de Sao Carlos, Sao Carlos, Sao Paulo eEscola de Medicina da Universidade de Minas Gerais, Belo Horizonte, Minas Gerais fHFSE - Hospital Federal dos Servidores do Estado, Rio de Janeiro gEscola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil hEunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland iUniversity of California, San Francisco, California, USA.
AIDS. 2017 Mar 13;31(5):669-679. doi: 10.1097/QAD.0000000000001393.
HIV-exposed uninfected (HEUs) infants have frequent severe infection, hospitalization, and death. We performed a serologic investigation to determine the role of common childhood respiratory pathogens in the excess incidence of infections in HEUs.
Prospective cohort study of mother-infant pairs.
Among 247 HEUs and 88 HIV-unexposed uninfected (HUU) infant-mother pairs, we measured maternal antibodies to respiratory syncytial virus (RSV) and pneumococcus (PNC 1, 5, 6B, 14); infant antibodies to RSV, influenza A (flu), parainfluenza viruses (1, 2, 3), and PNC 1, 5, 6B, and 14 were measured at 0 and 6 months, and antitetanus antibodies at 6 months.
HIV-infected mothers had higher RSV and lower PNC antibody concentrations at delivery than uninfected mothers. Transplacental transfer of maternal antibodies, particularly for RSV, was lower in HEUs compared with HUUs. At birth, HEUs had higher concentrations of anti-RSV antibodies than HUUs, but lower antibodies to the other respiratory agents. At 6 months, HEUs had significantly higher proportions of seroconversions and higher antibody concentrations against parainfluenza viruses 1, 2, and 3. There were no significant differences in seroconversions to flu and RSV, but antibody concentrations to RSV were six-fold lower in HEUs versus HUUs at 6 months. Antibody responses to at least two doses of tetanus vaccine were also six-fold lower in HEUs compared with HUUs.
Six-month-old HEUs had a higher incidence of respiratory viral infections than HUUs. In addition to the low passive protection from maternal antibodies, low antibody responses of HEUs may contribute to increased morbidity and mortality.
暴露于HIV但未感染（HEU）的婴儿频繁出现严重感染、住院和死亡情况。我们进行了一项血清学调查，以确定常见儿童呼吸道病原体在HEU婴儿感染发生率过高方面所起的作用。
母婴对的前瞻性队列研究。
在247对HEU母婴对和88对未暴露于HIV且未感染（HUU）的母婴对中，我们检测了母亲针对呼吸道合胞病毒（RSV）和肺炎球菌（PNC 1、5、6B、14）的抗体；在0个月和6个月时检测婴儿针对RSV、甲型流感病毒（流感）、副流感病毒（1、2、3）以及PNC 1、5、6B和14的抗体，并在6个月时检测抗破伤风抗体。
与未感染的母亲相比，感染HIV的母亲在分娩时RSV抗体浓度较高，PNC抗体浓度较低。与HUU婴儿相比，HEU婴儿中母体抗体的胎盘转运，尤其是针对RSV的转运较低。出生时，HEU婴儿的抗RSV抗体浓度高于HUU婴儿，但针对其他呼吸道病原体的抗体浓度较低。在6个月时，HEU婴儿中针对副流感病毒1、2和3的血清转化率显著更高，抗体浓度也更高。在流感和RSV的血清转化率方面没有显著差异，但在6个月时，HEU婴儿针对RSV的抗体浓度比HUU婴儿低6倍。与HUU婴儿相比，HEU婴儿对至少两剂破伤风疫苗的抗体反应也低6倍。
6个月大的HEU婴儿呼吸道病毒感染的发生率高于HUU婴儿。除了来自母体抗体的被动保护较低外，HEU婴儿的低抗体反应可能导致发病率和死亡率增加。
