Journal
AIDS
Volume 36, Issue 14, Pages 2045-2055Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0000000000003365
Keywords
antiretroviral; herd immunity; HIV; Malawi; pneumococcal carriage; pneumococcal conjugate vaccine; risk factors
Categories
Funding
- UK Medical Research Council (MRC)
- UK Department for International Development (DFID) under the MRC/DFID Concordat agreement
- European Union [MR/N023129/1]
- Wellcome [106846/Z/15/Z, WT091909/B/10/Z]
- Wellcome, UK
- UK aid from the UK Government [16/136/46]
- Bill & Melinda Gates Foundation [OPP1117653]
- Sir Henry Dale Fellowship - Wellcome Trust [208812/Z/17/Z]
- Sir Henry Dale Fellowship - Royal Society [208812/Z/17/Z]
- Bill and Melinda Gates Foundation [OPP1117653] Funding Source: Bill and Melinda Gates Foundation
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A study found that although ART duration reduced overall carriage and vaccine-serotype carriage, there is evidence of incomplete vaccine-serotype indirect protection in African ALWHIV. Targeted-vaccination campaigns and other public health measures should be considered to further reduce vaccine-serotype carriage and disease.
Objective: 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. Methods: 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. Results: 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. Conclusion: 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.
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