Keddy Karen H, Takuva Simbarashe, Musekiwa Alfred, Puren Adrian J, Sooka Arvinda, Karstaedt Alan, Klugman Keith P, Angulo Frederick J
Centre for Enteric Diseases, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2017 Mar 6;12(3):e0173091. doi: 10.1371/journal.pone.0173091. eCollection 2017.
HIV-infected persons are at increased risk of opportunistic infections, including invasive nontyphoidal Salmonella (iNTS) infections; antiretroviral therapy (ART) reduces this risk. We explored changing iNTS incidence associated with increasing ART availability in South Africa.
Laboratory-based surveillance for iNTS was conducted in Gauteng Province, South Africa, with verification using the National Health Laboratory Service's Central Data Warehouse (CDW), between 2003 and 2013. Isolates were serotyped at the Centre for Enteric Diseases. CDW data on patient numbers obtaining HIV viral load measurements provided estimates of numbers of HIV-infected patients receiving ART. A Poisson regression model was used to measure the changing incidence of iNTS infection from 2003 to 2013. The correlation between the incidence of iNTS and ART use from 2004 to 2013 was determined using Pearson's correlation coefficient.
From 2003-2013, the incidence of iNTS per 100,000 population per year decreased from 5.0 to 2.2 (p < .001). From 2004 to 2013, the incidence per 100,000 population of HIV viral load testing increased from 75.2 to 3,620.3 (p < .001). The most common serotypes causing invasive disease were Salmonella enterica serovar Typhimurium (Salmonella Typhimurium), and Salmonella Enteritidis: 2,469 (55.4%) and 1,156 (25.9%) of 4,459 isolates serotyped, respectively. A strong negative correlation was observed between decreasing iNTS incidence and increasing ART use from 2004 to 2013 (r = -0.94, p < .001). Similarly, decreasing incidence of invasive Salmonella Typhimurium infection correlated with increasing ART use (r = -0.93, p < .001). Incidence of invasive Salmonella Enteritidis infection increased, however (r = 0.95, p < .001). Between 2003 and 2004, fewer adult men than women presented with iNTS (male-to-female rate ratio 0.73 and 0.89, respectively). This was reversed from 2005 through 2013 (ranging from 1.07 in 2005 to 1.44 in 2013). Adult men accessed ART less (male-to-female rate ratio ranging from 0.61 [2004] to 0.67 [2013]).
The incidence of iNTS infections including Salmonella Typhimurium decreased significantly in Gauteng Province in association with increased ART utilization. Adult men accessed ART programs less than women, translating into increasing iNTS incidence in this group. Monitoring iNTS incidence may assist in monitoring the ART program. Increasing incidence of invasive Salmonella Enteritidis infections needs further elucidation.
艾滋病毒感染者发生机会性感染的风险增加，包括侵袭性非伤寒沙门氏菌（iNTS）感染；抗逆转录病毒疗法（ART）可降低这种风险。我们探讨了在南非随着ART可及性增加iNTS发病率的变化情况。
2003年至2013年期间，在南非豪登省开展了基于实验室的iNTS监测，并使用国家卫生实验室服务中心的数据仓库（CDW）进行核查。分离株在肠道疾病中心进行血清分型。CDW中关于接受艾滋病毒病毒载量检测患者数量的数据提供了接受ART的艾滋病毒感染患者数量的估计值。使用泊松回归模型来衡量2003年至2013年期间iNTS感染发病率的变化。使用Pearson相关系数确定2004年至2013年期间iNTS发病率与ART使用之间的相关性。
2003年至2013年期间，每年每10万人口中iNTS的发病率从5.0降至2.2（p < 0.001）。2004年至2013年期间，每10万人口中艾滋病毒病毒载量检测的发病率从75.2增至3620.3（p < 0.001）。引起侵袭性疾病的最常见血清型为肠炎沙门氏菌鼠伤寒血清型（鼠伤寒沙门氏菌）和肠炎沙门氏菌：在4459株进行血清分型的分离株中，分别为2469株（55.4%）和1156株（25.9%）。2004年至2013年期间，观察到iNTS发病率下降与ART使用增加之间存在强烈的负相关（r = -0.94，p < 0.001）。同样，侵袭性鼠伤寒沙门氏菌感染发病率下降与ART使用增加相关（r = -0.93，p < 0.001）。然而，侵袭性肠炎沙门氏菌感染的发病率增加（r = 0.95，p < 0.001）。2003年至2004年期间，出现iNTS的成年男性少于女性（男女比例分别为0.73和0.89）。2005年至2013年期间这种情况发生了逆转（2005年为1.07，2013年为1.44）。成年男性接受ART的比例较低（男女比例从2004年的0.61至2013年的0.67）。
在豪登省，包括鼠伤寒沙门氏菌在内的iNTS感染发病率随着ART利用率的增加而显著下降。成年男性接受ART项目的比例低于女性，这导致该群体中iNTS发病率上升。监测iNTS发病率可能有助于监测ART项目。侵袭性肠炎沙门氏菌感染发病率增加的情况需要进一步阐明。
