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O079 - ADULTS LIVING WITH HIV ON ANTIRETROVIRAL THERAPY EXHIBIT PROLONGED HIGH-DENSITY PNEUMOCOCCAL CARRIAGE AND SHED ANTIMICROBIAL-RESISTANT PNEUMOCOCCI (ID 100)
Abstract
Background
Despite the successful rollout of the pneumococcal conjugate vaccines, vaccine serotype (VT) carriage remains high among People Living with HIV (PLHIV) on antiretroviral therapy (ART). We investigated the impact of HIV infection on pneumococcal carriage duration, density, shedding, and antimicrobial resistance (AMR).
Methods
In a prospective cohort study, we recruited 90 asymptomatic PLHIV on ART and 54 HIV-uninfected adults aged 18-45 years and followed them up at regular intervals for 12 months. Standard microbiological techniques were used to test for pneumococcal presence and density on the nasopharyngeal swab and shedding specimens (cough, nose poke, and facemask). Disk diffusion using oxacillin, tetracycline, erythromycin, and co-trimoxazole was performed to screen AMR.
Results
PLHIV on ART had a longer duration of pneumococcal carriage (133 [95% CI 112-140] vs. 49 [95% CI 26-66] days; p=0.0012) and higher pneumococcal carriage density (51088 [95% CI 27542-95499] vs. 7630 [95% CI 3467-16218] CFU/ml; p=0.0394) than HIV-uninfected adults. PLHIV on ART were more likely to shed pneumococcus than HIV-uninfected adults (46% vs 25%; p=0.002). Shed isolates were more often multidrug-resistant (MDR) than the nasopharyngeal carriage isolates (57% vs. 36%; p=0.0015). A generalized linear mixed model demonstrated that being HIV-infected on ART (p=0.017) or having a higher carriage density (p=0.0002) were independently associated with increased pneumococcal shedding.
Conclusions
We have demonstrated profoundly greater risks of pneumococcal carriage and shedding among PLHIV on ART compared to HIV-uninfected adults. These findings suggest that PLHIV on ART could be an important reservoir of pneumococcal transmission, including AMR pneumococci.