Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Malawi-Liverpool-Wellcome Programme.
AIDS. 2022 Nov 15;36(14):2045-2055. doi: 10.1097/QAD.0000000000003365. Epub 2022 Aug 19.
Adults living with HIV (ALWHIV) on antiretroviral therapy (ART) are at high risk of pneumococcal carriage and disease. To help evaluate carriage risk in African ALWHIV at least 4 years after infant pneumococcal conjugate vaccination introduction in 2011, we assessed association between pneumococcal carriage and potential risk factors.
Nasopharyngeal swabs were collected from adults aged 18-40 years attending an ART clinic during rolling, cross-sectional surveys in Blantyre, Malawi between 2015 and 2019. We fitted generalized additive models to estimate the risk of sex, social economic status (SES), living with a child less than 5 years, and ART duration on carriage.
Of 2067 adults, median age was 33 years (range 28-37), 1427 (69.0%) were women, 1087 (61.4%) were in low-middle socioeconomic-status (SES), 910 (44.0%) were living with a child less than 5 years, and median ART duration was 3 years (range 0.004-17). We estimated 38.2 and 60.6% reductions in overall and vaccine-serotype carriage prevalence. Overall carriage was associated with low SES, living with a child less than 5 years and shorter duration on ART. By contrast, vaccine-type carriage was associated with living without a child less than 5 years and male sex.
Despite temporal reductions in overall and vaccine-serotype carriage, there is evidence of incomplete vaccine-serotype indirect protection. A targeted-vaccination campaign should be considered for ALWHIV, along with other public health measures to further reduce vaccine-serotype carriage and therefore disease.
接受抗逆转录病毒疗法（ART）的艾滋病毒感染者（ALWHIV）发生肺炎球菌携带和疾病的风险很高。为了评估 2011 年婴儿肺炎球菌结合疫苗引入至少 4 年后非洲 ALWHIV 的携带风险，我们评估了肺炎球菌携带与潜在危险因素之间的关系。
在马拉维布兰太尔的一个 ART 诊所，我们于 2015 年至 2019 年期间进行了滚动、横断面调查，采集了 18-40 岁成人的鼻咽拭子。我们使用广义加性模型来估计性别的、社会经济地位（SES）的、与 5 岁以下儿童一起生活以及 ART 持续时间对携带的风险。
在 2067 名成年人中，中位年龄为 33 岁（范围 28-37），1427 名（69.0%）为女性，1087 名（61.4%）为中低收入 SES，910 名（44.0%）与 5 岁以下儿童一起生活，ART 持续时间中位数为 3 年（范围 0.004-17）。我们估计总体和疫苗血清型携带率分别降低了 38.2%和 60.6%。总体携带与 SES 较低、与 5 岁以下儿童生活在一起和 ART 持续时间较短有关。相比之下，疫苗型携带与没有 5 岁以下儿童生活在一起和男性性别有关。
尽管总体和疫苗血清型携带率呈下降趋势，但仍有证据表明不完全的疫苗血清型间接保护。应该考虑针对 ALWHIV 进行有针对性的疫苗接种运动，同时采取其他公共卫生措施，以进一步降低疫苗血清型的携带率，从而减少疾病。
