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Frequent shedding of multi-drug resistant pneumococci among adults living with HIV on suppressive antiretroviral therapy in Malawi

Sibale, L.; Phiri, J.; Mitole, N.; Kalata, N.; Nyazika, T.; Kalirani, A.; Khwiya, M.; Sagawa, G.; Thindwa, D.; Swarthout, T.; French, N.; Malisita, K.; Kamn'gona, A.; Ferreira, D.; Heyderman, R. S.; Kwambana-Adams, B.; Jambo, K. C.

2022-10-31 infectious diseases
10.1101/2022.10.28.22281638 medRxiv
Show abstract

People living with human immunodeficiency virus (PLHIV) on antiretroviral therapy (ART) are reported to have three times higher carriage of Streptococcus pneumoniae than their HIV-uninfected counterparts in point prevalence studies. Using a longitudinal cohort study design, we assessed pneumococcal carriage density, shedding and antibiotic resistance profiles, as well as nasal mucosal immunity, in otherwise healthy PLHIV on ART for at least one year, compared to HIV-uninfected participants in Malawi. Pneumococcal carriage density was higher among PLHIV compared to HIV-uninfected participants. Moreover, PLHIV were twice more likely to shed pneumococci than HIV-uninfected participants. In PLHIV, aerosol shed pneumococci were more often multi-drug resistant (MDR) than nasopharyngeal carried isolates recovered from the same individual. Consistent with high shedding, PLHIV exhibited heightened neutrophil-mediated nasal mucosa inflammation. We propose that PLHIV should be considered in intervention strategies, such as vaccination, as they could be an important reservoir for transmission of MDR S. pneumoniae.

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