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Maloupazoa Siawaya AC, Kuissi Kamgaing E, Minto'o Rogombe S, Obiang T, Moungoyi Massala E, Magossou Mbadinga MJV, Leboueny M, Mvoundza Ndjindji O, Mveang-Nzoghe A, Ondo JP, Mintsa Ndong A, N Essone P, Agnandji ST, Kaba M, Ategbo S, Djoba Siawaya JF. HIV-exposed uninfected compared with unexposed infants show the presence of leucocytes, lower lactoferrin levels and antimicrobial-resistant micro-organisms in the stool. Paediatr Int Child Health 2019; 39:249-258. [PMID: 30762489 DOI: 10.1080/20469047.2019.1577063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: HIV-exposed uninfected (HEU)-infants have been shown to be particularly vulnerable to infections. In this population, disturbance of the gut micro-environment might increase their susceptibility to enteric diseases and even favour the translocation of bacteria in the bloodstream. Methods: The gastro-intestinal micro-environment was explored in 22 HEU infants and 16 HIV-unexposed (HU) infants aged 6-24 weeks. Faecal leucocytes, firmicutes (gram-positive bacteria) and gracilicutes (gram-negative bacteria) were assessed by cytology. Faecal lactoferrin and sIgA were measured by ELISA. The spectrum of micro-organisms in infants' stool was analysed by culturing. Results: HEU infants were 14 times more likely to have leucocytes in their stool than HU infants (p < 0.005). The lactoferrin level was significantly lower in HEU infants than in HU infants (p = 0.02). Potentially pathogenic bacteria such as Escherichia coli were more prevalent in HEU than in HU infants (64% vs 23.5%). Also, E. coli strains resistant to key antibiotics including co-trimoxazole, β-lactam (cephalosporins included) and tetraclines were observed in some HEU infants. Conclusion: HEU infants are more likely to present an inflamed digestive tract as highlighted by the presence of leucocytes. In addition, there is a real risk of colonisation of HEU infants' microbiota by resistant micro-organisms.
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Affiliation(s)
- A C Maloupazoa Siawaya
- Laboratoire National de Santé Publique, Unités de Recherche et de Diagnostics Spécialisés , Libreville , Gabon.,Service Laboratoire, Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori , Libreville , Gabon
| | - E Kuissi Kamgaing
- Département de Pédiatrie, Université des Sciences de la Santé , Libreville , Gabon
| | - S Minto'o Rogombe
- Département de Pédiatrie, Université des Sciences de la Santé , Libreville , Gabon
| | - T Obiang
- Département de Pédiatrie, Université des Sciences de la Santé , Libreville , Gabon
| | - E Moungoyi Massala
- Département de Chimie, Faculté des Sciences, Université des Sciences et Techniques de Masuku , Franceville , Gabon
| | - M J V Magossou Mbadinga
- Laboratoire National de Santé Publique, Unités de Recherche et de Diagnostics Spécialisés , Libreville , Gabon.,Service Laboratoire, Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori , Libreville , Gabon
| | - M Leboueny
- Laboratoire National de Santé Publique, Unités de Recherche et de Diagnostics Spécialisés , Libreville , Gabon.,Service Laboratoire, Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori , Libreville , Gabon
| | - O Mvoundza Ndjindji
- Laboratoire National de Santé Publique, Unités de Recherche et de Diagnostics Spécialisés , Libreville , Gabon.,Service Laboratoire, Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori , Libreville , Gabon
| | - A Mveang-Nzoghe
- Laboratoire National de Santé Publique, Unités de Recherche et de Diagnostics Spécialisés , Libreville , Gabon.,Service Laboratoire, Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori , Libreville , Gabon
| | - J P Ondo
- Département de Chimie, Faculté des Sciences, Université des Sciences et Techniques de Masuku , Franceville , Gabon
| | - A Mintsa Ndong
- Laboratoire National de Santé Publique, Unité de Virologie , Libreville , Gabon
| | - P N Essone
- Laboratoire National de Santé Publique, Unités de Recherche et de Diagnostics Spécialisés , Libreville , Gabon.,Centre de Recherches Médicales de Lambaréné , Lambaréné , Gabon.,Institut für Tropenmedizin, Universitätsklinikum Tübingen , Tübingen , Germany
| | - S T Agnandji
- Centre de Recherches Médicales de Lambaréné , Lambaréné , Gabon.,Institut für Tropenmedizin, Universitätsklinikum Tübingen , Tübingen , Germany
| | - M Kaba
- Division of Medical Microbiology, University of Cape Town , Cape Town , South Africa
| | - S Ategbo
- Département de Pédiatrie, Université des Sciences de la Santé , Libreville , Gabon
| | - J F Djoba Siawaya
- Laboratoire National de Santé Publique, Unités de Recherche et de Diagnostics Spécialisés , Libreville , Gabon.,Service Laboratoire, Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori , Libreville , Gabon
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2
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Nyangulu WJ, Mwinjiwa E, Divala TH, Mungwira RG, Nyirenda O, Kanjala M, Mbambo G, Mallewa J, Taylor TE, Laurens MB, Laufer MK, van Oosterhout JJ. Frequent malaria illness episodes in two Malawian patients on antiretroviral therapy soon after stopping cotrimoxazole preventive therapy. Malawi Med J 2017; 29:57-60. [PMID: 28567199 DOI: 10.4314/mmj.v29i1.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We describe two Malawian adults on successful antiretroviral therapy who experienced frequent malaria episodes after stopping cotrimoxazole prophylaxis. We argue that, in addition to stopping cotrimoxazole, diminished malaria immunity and drug interactions between efavirenz and artemether-lumefantrine may have played a causative role in the recurrent malaria our patients experienced.
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Affiliation(s)
| | | | - Titus H Divala
- Blantyre Malaria Project, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Randy G Mungwira
- Blantyre Malaria Project, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Osward Nyirenda
- Blantyre Malaria Project, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Maxwell Kanjala
- Blantyre Malaria Project, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gillian Mbambo
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jane Mallewa
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Terrie E Taylor
- Blantyre Malaria Project, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Matthew B Laurens
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Miriam K Laufer
- Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Joep J van Oosterhout
- Dignitas International, Zomba, Malawi.,Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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3
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Hobbs CV, Anderson C, Neal J, Sahu T, Conteh S, Voza T, Langhorne J, Borkowsky W, Duffy PE. Trimethoprim-Sulfamethoxazole Prophylaxis During Live Malaria Sporozoite Immunization Induces Long-Lived, Homologous, and Heterologous Protective Immunity Against Sporozoite Challenge. J Infect Dis 2016; 215:122-130. [PMID: 28077589 DOI: 10.1093/infdis/jiw482] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/30/2016] [Indexed: 11/12/2022] Open
Abstract
Trimethoprim-sulfamethoxazole (TMP-SMX) is widely used in malaria-endemic areas in human immunodeficiency virus (HIV)-infected children and HIV-uninfected, HIV-exposed children as opportunistic infection prophylaxis. Despite the known effects that TMP-SMX has in reducing clinical malaria, its impact on development of malaria-specific immunity in these children remains poorly understood. Using rodent malaria models, we previously showed that TMP-SMX, at prophylactic doses, can arrest liver stage development of malaria parasites and speculated that TMP-SMX prophylaxis during repeated malaria exposures would induce protective long-lived sterile immunity targeting pre-erythrocytic stage parasites in mice. Using the same models, we now demonstrate that repeated exposures to malaria parasites during TMP-SMX administration induces stage-specific and long-lived pre-erythrocytic protective anti-malarial immunity, mediated primarily by CD8+ T-cells. Given the HIV infection and malaria coepidemic in sub-Saharan Africa, clinical studies aimed at determining the optimum duration of TMP-SMX prophylaxis in HIV-infected or HIV-exposed children must account for the potential anti-infection immunity effect of TMP-SMX prophylaxis.
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Affiliation(s)
- Charlotte V Hobbs
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland.,Division of Infectious Diseases, Department of Pediatrics.,Department of Microbiology, Batson Children's Hospital, University of Mississippi Medical Center, Jackson.,Division of Infectious Disease and Immunology, Department of Pediatrics, New York University School of Medicine
| | - Charles Anderson
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Jillian Neal
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Tejram Sahu
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Solomon Conteh
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
| | - Tatiana Voza
- Biological Sciences Department, New York City College of Technology, City University of New York
| | - Jean Langhorne
- Mill Hill Laboratory, Francis Crick Institute, London, United Kingdom
| | - William Borkowsky
- Division of Infectious Disease and Immunology, Department of Pediatrics, New York University School of Medicine
| | - Patrick E Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland
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HIV-Exposed Uninfected Infants Show Robust Memory B-Cell Responses in Spite of a Delayed Accumulation of Memory B Cells: an Observational Study in the First 2 Years of Life. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:576-85. [PMID: 27170641 PMCID: PMC4933775 DOI: 10.1128/cvi.00149-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/01/2016] [Indexed: 11/20/2022]
Abstract
Improved HIV care has led to an increase in the number of HIV-exposed uninfected (HEU) infants born to HIV-infected women. Although they are uninfected, these infants experience increased morbidity and mortality. One explanation may be that their developing immune system is altered by HIV exposure, predisposing them to increased postnatal infections. We explored the impact of HIV exposure on the B-cell compartment by determining the B-cell subset distribution, the frequency of common vaccine antigen-specific memory B cells (MBCs), and the levels of antibodies to the respective antigens in HEU and HIV-unexposed uninfected (HUU) infants born to uninfected mothers, using flow cytometry, a B-cell enzyme-linked immunosorbent spot assay, and an enzyme-linked immunosorbent assay, respectively, during the first 2 years of life. For the majority of the B-cell subsets, there were no differences between HEU and HUU infants. However, HIV exposure was associated with a lower proportion of B cells in general and MBCs in particular, largely due to a lower proportion of unswitched memory B cells. This reduction was maintained even after correcting for age. These phenotypic differences in the MBC compartment did not affect the ability of HEU infants to generate recall responses to previously encountered antigens or reduce the antigen-specific antibody levels at 18 months of life. Although HIV exposure was associated with a transient reduction in the proportion of MBCs, we found that the ability of HEU infants to mount robust MBC and serological responses was unaffected.
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Longwe H, Phiri KS, Mbeye NM, Gondwe T, Mandala WL, Jambo KC. Delayed acquisition of Plasmodium falciparum antigen-specific CD4(+) T cell responses in HIV-exposed uninfected Malawian children receiving daily cotrimoxazole prophylaxis. Malar J 2016; 15:264. [PMID: 27165269 PMCID: PMC4862093 DOI: 10.1186/s12936-016-1318-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/28/2016] [Indexed: 11/16/2022] Open
Abstract
Background Cotrimoxazole (CTX) prophylaxis, recommended in HIV-exposed uninfected (HEU) children primarily against HIV-related opportunistic infections, has been shown to have some efficacy against Plasmodium falciparum malaria. The effects of CTX prophylaxis on the acquisition of P. falciparum antigen specific CD4+ T cells-mediated immunity in HEU children is still not fully understood. Methods Peripheral blood was collected from HEU and HIV-unexposed uninfected (HUU) children at 6, 12 and 18 months of age. Proportion of CD4+ T cells subsets were determined by immunophenotyping. P. falciparum antigen-specific CD4+ T cells responses were measured by intracellular cytokine staining assay. Results There were no differences in the proportions of naïve, effector and memory CD4+ T cell subsets between HEU and HUU children at all ages. There was a trend showing acquisition of P. falciparum-specific IFN-γ and TNF-producing CD4+ T cells with age in both HUU and HEU children. There was, however, lower frequency of P. falciparum-specific IFN-γ-producing CD4+ T cells in HEU compared to HUU at 6 and 12 months, which normalized 6 months after stopping CTX prophylaxis. Conclusion The results demonstrate that there is delayed acquisition of P. falciparum-specific IFN-γ-producing CD4+ T cells in HEU children on daily cotrimoxazole prophylaxis, which is evident at 6 and 12 months of age in comparison to HUU age-matched controls. However, whether this delayed acquisition of P. falciparum-specific IFN-γ-producing CD4+ T cells leads to higher risk to malaria disease remains unknown and warrants further investigation.
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Affiliation(s)
- Herbert Longwe
- Department of Basic Medical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi. .,Tropical Haematology Research Unit, College of Medicine, University of Malawi, Blantyre, Malawi.
| | - Kamija S Phiri
- Tropical Haematology Research Unit, College of Medicine, University of Malawi, Blantyre, Malawi.,Department of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Nyanyiwe M Mbeye
- Tropical Haematology Research Unit, College of Medicine, University of Malawi, Blantyre, Malawi.,Department of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Thandile Gondwe
- Tropical Haematology Research Unit, College of Medicine, University of Malawi, Blantyre, Malawi.,Department of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Wilson L Mandala
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Kondwani C Jambo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi. .,Liverpool School of Tropical Medicine, Liverpool, UK.
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6
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Kasirye RP, Baisley K, Munderi P, Levin J, Anywaine Z, Nunn A, Kamali A, Grosskurth H. Incidence of malaria by cotrimoxazole use in HIV-infected Ugandan adults on antiretroviral therapy: a randomised, placebo-controlled study. AIDS 2016; 30:635-44. [PMID: 26558729 PMCID: PMC4732005 DOI: 10.1097/qad.0000000000000956] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 10/12/2015] [Accepted: 10/21/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Previous unblinded trials have shown increased malaria among HIV-infected adults on antiretroviral therapy (ART) who stop cotrimoxazole (CTX) prophylaxis. We investigated the effect of stopping CTX on malaria in HIV-infected adults on ART in a double-blind, placebo-controlled trial. METHODS HIV-infected Ugandan adults stable on ART and CTX with CD4 cell count at least 250 cells/μl were randomized (1 : 1) to continue CTX or stop CTX and receive matching placebo (COSTOP trial; ISRCTN44723643). Clinical malaria was defined as fever and a positive blood slide, and considered severe if a participant had at least one clinical or laboratory feature of severity or was admitted to hospital. Malaria incidence and rate ratios were estimated using random effects Poisson regression, accounting for multiple episodes. RESULTS A total of 2180 participants were enrolled and followed for a median of 2.5 years; 453 malaria episodes were recorded. Malaria incidence was 9.1/100 person-years (pyrs) [95% confidence interval (CI) = 8.2-10.1] and was higher on placebo (rate ratio 3.47; CI = 2.74-4.39). Malaria in the placebo arm decreased over time; although incidence remained higher than in the CTX arm, the difference between arms reduced slightly (interaction P value = 0.10). Fifteen participants experienced severe malaria (<1%); overall incidence was 0.30/100 pyrs (CI = 0.18-0.49). There was one malaria-related death (CTX arm). CONCLUSION HIV-infected adults - who are stable on ART and stop prophylactic CTX - experience more malaria than those that continue, but this difference is less than has been reported in previous trials. Few participants had severe malaria. Further research might be useful in identifying groups that can safely stop CTX prophylaxis.
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Affiliation(s)
- Ronnie P. Kasirye
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Kathy Baisley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Paula Munderi
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Jonathan Levin
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Andrew Nunn
- MRC Clinical Trials Unit at University College London, UK
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7
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Longwe H, Phiri KS, Mbeye NM, Gondwe T, Jambo KC, Mandala WL. Proportions of CD4+, CD8+ and B cell subsets are not affected by exposure to HIV or to Cotrimoxazole prophylaxis in Malawian HIV-uninfected but exposed children. BMC Immunol 2015; 16:50. [PMID: 26315539 PMCID: PMC4552147 DOI: 10.1186/s12865-015-0115-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a result of successful PMTCT programs, children born from HIV-infected mothers are now effectively protected from contracting the infection. However, it is not well known whether in utero exposure to the virus and the subsequent exposure to Cotrimoxazole (CTX) prophylaxis affect the cell mediated immune system of the children. This observational prospective study was aimed at determining how CD4(+) T, CD8(+) T and B cell subsets varied in HIV-exposed but uninfected (HEU) children at different ages. METHODS We recruited HEU and HIV-unexposed and uninfected (HUU) children from 6 months of age and followed them up until they were 18 months old. HEU children received daily CTX prophylaxis beginning at 6 weeks of age until when 12 months of age. Venous blood samples were collected 6 monthly and analysed for different subsets of CD8(+) T, B cells and totalCD4(+) T cells. RESULTS At 6 months of age, HEU children had a lower percentage of total CD4(+) T cells compared to HUU children and a lower proportion of naïve CD8(+) T cells but higher percentage of effector memory CD8(+) T cells compared to HUU children. HEU and HUU children had similar proportions of all B cell subsets at all ages. CONCLUSIONS The study showed that the subtle variations in CD4(+) and CD8(+) T cell subsets observed at 6 months do not last beyond 12 months of age, suggesting that HEU children have a robust cell-mediated immune system during first year of life. TRIAL REGISTRATION This article report is not based on results of a controlled health-care intervention.
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Affiliation(s)
- Herbert Longwe
- Department of Basic Medical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi. .,Tropical Haematology Research Unit, College of Medicine, University of Malawi, Blantyre, Malawi.
| | - Kamija S Phiri
- Tropical Haematology Research Unit, College of Medicine, University of Malawi, Blantyre, Malawi.
| | - Nyanyiwe M Mbeye
- Tropical Haematology Research Unit, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Thandile Gondwe
- Department of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi.
| | - Kondwani C Jambo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
| | - Wilson L Mandala
- Department of Basic Medical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi. .,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
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