HIV exposed uninfected; Group B Streptococcus; newborn; Infant; inflammation; breast milk; HIV; pregnancy
Abstract :
[en] Group B Streptococcus (GBS) is a major cause of neonatal sepsis and mortality worldwide. Studies from both developed and developing countries have shown that HIV-exposed but uninfected (HEU) infants are at increased risk of infectious morbidity, as compared to HIV-unexposed uninfected infants (HUU). A higher susceptibility to GBS infections has been reported in HEU infants, particularly late-onset diseases and more severe manifestations of GBS diseases. We review here the possible explanations for increased susceptibility to GBS infection. Maternal GBS colonization during pregnancy is a major risk factor for early-onset GBS invasive disease, but colonization rates are not higher in HIV-infected compared to HIV-uninfected pregnant women, while selective colonization with more virulent strains in HIV-infected women is suggested in some studies. Lower serotype-speci c GBS maternal antibody transfer and quantitative and qualitative defects of innate immune responses in HEU infants may play a role in the increased risk of GBS invasive disease. The impact of maternal antiretroviral treatment and its consequences on immune activation in HEU newborns are important to study. Maternal immunization presents a promising intervention to reduce GBS burden in the growing HEU population.
Research Center/Unit :
CIRM - Centre Interdisciplinaire de Recherche sur le Médicament - ULiège
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics) Immunology & infectious disease Pediatrics
Author, co-author :
DAUBY, Nicolas; Université Libre de Bruxelles (ULB), CHU Saint-Pierre, Brussels > Department of Infectious Diseases & Institute for Medical Immunology
CHAMEKH, Mustapha; Université Libre de Bruxelles - ULB > Institute for Medical Immunology, Gosselies
MELIN, Pierrette ; Centre Hospitalier Universitaire de Liège - CHU > Service de microbiologie clinique
SLOGROVE, Amy L.; Stellenbosch University, Tygerberg, South Africa > Department of Paediatrics and Child Health > Division of Paediatric Infectious Diseases
GOETGHEBUER, Tessa; Université Libre de Bruxelles - ULB & CHU St Pierre Bruxelles > Department of Paediatrics
Language :
English
Title :
Increased Risk of Group B Streptococcus Invasive Infection in HIV-Exposed but Uninfected Infants: A Review of the Evidence and Possible Mechanisms.
Publication date :
16 November 2016
Journal title :
Frontiers in Immunology
eISSN :
1664-3224
Publisher :
Frontiers Research Foundation, Lausanne, Switzerland
Farley MM, Strasbaugh LJ. Group B streptococcal disease in nonpregnant adults. Clin Infect Dis (2001) 33(4):556-61. doi: 10.1086/322696
Melin P, Efstratiou A. Group B streptococcal epidemiology and vaccine needs in developed countries. Vaccine (2013) 31:D31-42. doi:10.1016/j.vaccine.2013.05.012
Edmond KM, Kortsalioudaki C, Scott S, Schrag SJ, Zaidi AK, Cousens S, et al. Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis. Lancet (2012) 379(9815):547-56. doi:10.1016/S0140-6736(11)61651-6
Dangor Z, Lala SG, Cutland CL, Koen A, Jose L, Nakwa F, et al. Burden of invasive Group B Streptococcus disease and early neurological sequelae in South African infants. PLoS One (2015) 10(4):e0123014. doi:10.1371/journal.pone.0123014
Berardi A, Rossi C, Lugli L, Creti R, Bacchi Reggiani ML, Lanari M, et al. Group B Streptococcus late-onset disease: 2003-2010. Pediatrics (2013) 131(2):e361-8. doi:10.1542/peds.2012-1231
Boyer KM, Gotoff SP. Prevention of early-onset neonatal Group B Streptococcal disease with selective intrapartum chemoprophylaxis. N Engl J Med (1986) 314(26):1665-9. doi:10.1056/NEJM198606263142603
Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal Group B streptococcal disease. MMWR Recomm Rep (2002) 51(11):1-22.
Superior Health Council. Prevention of Perinatal Group B Streptococcal Infections. Brussels: Service Public Fédéral Santé Publique, Sécurité de la Chaîne Alimentaire et Environnement (2003).
Melin P. Neonatal Group B streptococcal disease: from pathogenesis to preventive strategies. Clin Microbiol Infect (2011) 17(9):1294-303. doi:10.1111/j.1469-0691.2011.03576.x
Slogrove AL, Goetghebuer T, Cotton MF, Singer J, Bettinger JA. Pattern of infectious morbidity in HIV exposed uninfected infants and children. Front Immunol (2016) 7:164. doi:10.3389/fimmu.2016.00164
Mussi-Pinhata MM, Freimanis L, Yamamoto AY, Korelitz J, Pinto JA, Cruz MLS, et al. Infectious disease morbidity among young HIV-1-exposed but uninfected infants in Latin American and Caribbean countries: The National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study. Pediatrics (2007) 119(3):e694-704. doi:10.1542/peds.2006-1856
Taron-Brocard C, Le Chenadec J, Faye A, Dollfus C, Goetghebuer T, Gajdos V, et al. Increased risk of serious bacterial infections due to maternal immunosuppression in HIV-exposed uninfected infants in a European country. Clin Infect Dis (2014) 59(9):1332-45. doi:10.1093/cid/ciu586
Epalza C, Goetghebuer T, Hainaut M, Prayez F, Barlow P, Dediste A, et al. High incidence of invasive Group B streptococcal infections in HIV-exposed uninfected infants. Pediatrics (2010) 126(3):e631-8. doi:10.1542/peds.2010-0183
Cutland CL, Schrag SJ, Thigpen MC, Velaphi SC, Wadula J, Adrian PV, et al. Increased risk for Group B Streptococcus sepsis in young infants exposed to HIV, Soweto, South Africa, 2004-2008. Emerg Infect Dis (2015) 21(4):638. doi:10.3201/eid2104.141562
Eaton JW, Rehle TM, Jooste S, Nkambule R, Kim AA, Mahy M, et al. Recent HIV prevalence trends among pregnant women and all women in sub-Saharan Africa: implications for HIV estimates. AIDS (2014) 28:S507-14. doi:10.1097/QAD.0000000000000412
Kharsany AB, Frohlich JA, Yende-Zuma N, Mahlase G, Samsunder N, Dellar RC, et al. Trends in HIV prevalence in pregnant women in rural South Africa. J Acquir Immune Defic Syndr (2015) 70(3):289-95. doi:10.1097/QAI.0000000000000761
Dauby N, Goetghebuer T, Kollmann TR, Levy J, Marchant A. Uninfected but not unaffected: chronic maternal infections during pregnancy, fetal immunity, and susceptibility to postnatal infections. Lancet Infect Dis (2012) 12(4):330-40. doi:10.1016/S1473-3099(11)70341-3
Adler C, Haelterman E, Barlow P, Marchant A, Levy J, Goetghebuer T. Severe infections in HIV-exposed uninfected infants born in a European country. PLoS One (2015) 10(8):e0135375. doi:10.1371/journal.pone.0135375
Slogrove AL, Cotton MF, Esser MM. Severe infections in HIV-exposed uninfected infants: clinical evidence of immunodeficiency. J Trop Pediatr (2010) 56(2):75-81. doi:10.1093/tropej/fmp057
Slogrove A, Reikie B, Naidoo S, De Beer C, Ho K, Cotton M, et al. HIV-exposed uninfected infants are at increased risk for severe infections in the first year of life. J Trop Pediatr (2012) 58(6):505-8. doi:10.1093/tropej/fms019
Barron P, Pillay Y, Doherty T, Sherman G, Jackson D, Bhardwaj S, et al. Eliminating mother-to-child HIV transmission in South Africa. Bull World Health Organ (2013) 91(1):70-4. doi:10.2471/BLT.12.106807
Tazi A, Bellais S, Tardieux I, Dramsi S, Trieu-Cuot P, Poyart C. Group B Streptococcus surface proteins as major determinants for meningeal tropism. Curr Opin Microbiol (2012) 15(1):44-9. doi:10.1016/j.mib.2011.12.002
Le Doare K, Heath PT. An overview of global GBS epidemiology. Vaccine (2013) 31:D7-12. doi:10.1016/j.vaccine.2013.01.009
Cutland CL, Schrag SJ, Zell ER, Kuwanda L, Buchmann E, Velaphi SC, et al. Maternal HIV infection and vertical transmission of pathogenic bacteria. Pediatrics (2012) 130(3):e581-90. doi:10.1542/peds.2011-1548
Gray KJ, Kafulafula G, Matemba M, Kamdolozi M, Membe G, French N. Group B Streptococcus and HIV infection in pregnant women, Malawi, 2008-2010. Emerg Infect Dis (2011) 17(10):1932-5. doi:10.3201/eid1710.102008
Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet (2013) 382(9903):1525-33. doi:10.1016/S0140-6736(13)61809-7
Jamieson DJ, Duerr A, Klein RS, Paramsothy P, Brown W, Cu-Uvin S, et al. Longitudinal analysis of bacterial vaginosis: findings from the HIV epidemiology research study. Obstet Gynecol (2001) 98(4):656-63. doi:10.1097/00006250-200110000-00023
Sewankambo N, Gray RH, Wawer MJ, Paxton L, McNairn D, Wabwire-Mangen F, et al. HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet (1997) 350(9077):546-50. doi:10.1016/S0140-6736(97)01063-5
Seale AC, Koech AC, Sheppard AE, Barsosio HC, Langat J, Anyango E, et al. Maternal colonization with Streptococcus agalactiae and associated stillbirth and neonatal disease in coastal Kenya. Nat Microbiol (2016) 1(7):16067. doi:10.1038/nmicrobiol.2016.67
Da Cunha V, Davies MR, Douarre P-E, Rosinski-Chupin I, Margarit I, Spinali S, et al. Streptococcus agalactiae clones infecting humans were selected and fixed through the extensive use of tetracycline. Nat Commun (2014) 5:4544. doi:10.1038/ncomms5544
Bender JM, Li F, Martelly S, Byrt E, Rouzier V, Leo M, et al. Maternal HIV infection influences the microbiome of HIV-uninfected infants. Sci Transl Med (2016) 8(349):ra100-349. doi:10.1126/scitranslmed.aaf5103
Dangor Z, Kwatra G, Izu A, Adrian P, van Niekerk N, Cutland CL, et al. HIV-1 is associated with lower Group B Streptococcus capsular and surface-protein IgG antibody levels and reduced transplacental antibody transfer in pregnant women. J Infect Dis (2015) 212(3):453-62. doi:10.1093/infdis/jiv064
Palmeira P, Quinello C, Silveira-Lessa AL, Zago CA, Carneiro-Sampaio M. IgG placental transfer in healthy and pathological pregnancies. Clin Dev Immunol (2012) 2012:13. doi:10.1155/2012/985646
Dangor Z, Kwatra G, Izu A, Lala SG, Madhi SA. Review on the association of Group B Streptococcus capsular antibody and protection against invasive disease in infants. Expert Rev Vaccines (2015) 14(1):135-49. doi:10.1586/14760584.2014.953939
Dangor Z, Lala SG, Kwatra G, Madhi SA. Group B Streptococcus: developing a correlate of protection for a vaccine against neonatal infections. Curr Opin Infect Dis (2016) 29(3):262-7. doi:10.1097/QCO.0000000000000266
Jones CE, Naidoo S, De Beer C, Esser M, Kampmann B, Hesseling AC. Maternal HIV infection and antibody responses against vaccine-preventable diseases in uninfected infants. JAMA (2011) 305(6):576-84. doi:10.1001/jama.2011.100
Reikie BA, Naidoo S, Ruck CE, Slogrove AL, de Beer C, la Grange H, et al. Antibody responses to vaccination among South African HIV-exposed and unexposed uninfected infants during the first 2 years of life. Clin Vaccine Immunol (2013) 20(1):33-8. doi:10.1128/CVI.00557-12
Madhi SA, Izu A, Violari A, Cotton MF, Panchia R, Dobbels E, et al. Immunogenicity following the first and second doses of 7-valent pneumococcal conjugate vaccine in HIV-infected and-uninfected infants. Vaccine (2013) 31(5):777-83. doi:10.1016/j.vaccine.2012.11.076
Abu Raya B, Smolen K, Willems F, Kollmann T, Marchant A. Transfer of maternal anti-microbial immunity to HIV-exposed uninfected newborns. Front Immunol (2016) 7:338. doi:10.3389/fimmu.2016.00338
Wedi CO, Kirtley S, Hopewell S, Corrigan R, Kennedy SH, Hemelaar J. Perinatal outcomes associated with maternal HIV infection: a systematic review and meta-analysis. Lancet HIV (2016) 3(1):e33-48. doi:10.1016/S2352-3018(15)00207-6
Mofenson LM. Antiretroviral therapy and adverse pregnancy outcome: the elephant in the room? J Infect Dis (2016) 213(7):1051-4. doi:10.1093/infdis/jiv390
Lopez M, Figueras F, Hernandez S, Lonca M, Garcia R, Palacio M, et al. Association of HIV infection with spontaneous and iatrogenic preterm delivery: effect of HAART. AIDS (2012) 26(1):37-43. doi:10.1097/QAD.0b013e32834db300
Moir S, Malaspina A, Ho J, Wang W, DiPoto AC, O'Shea MA, et al. Normalization of B cell counts and subpopulations after antiretroviral therapy in chronic HIV disease. J Infect Dis (2008) 197(4):572-9. doi:10.1086/526789
Le Doare K, Allen L, Kampmann B, Heath PT, Taylor S, Hesseling AC, et al. Anti-Group B Streptococcus antibody in infants born to mothers with human immunodeficiency virus (HIV) infection. Vaccine (2015) 33(5):621-7. doi:10.1016/j.vaccine.2014.12.025
Hall MA, Edwards MS, Baker CJ. Complement and antibody participation in opsonophagocytosis of type IV and V Group B streptococci. Infect Immun (1992) 60(12):5030-5.
Edwards MS, Lane HJ, Hillier SL, Rench MA, Baker CJ. Persistence of functional antibodies to Group B streptococcal capsular polysaccharides following immunization with glycoconjugate vaccines. Vaccine (2012) 30(28):4123-6. doi:10.1016/j.vaccine.2012.04.048
Kwatra G, Adrian P, Shiri T, Buchmann E, Cutland C, Madhi S. Natural acquired humoral immunity against serotype-specific Group B Streptococcus rectovaginal colonization acquisition in pregnant women. Clin Microbiol Infect (2015) 21(6):568.e13-21. doi:10.1016/j.cmi.2015.01.030
Lawrence RM, Lawrence RA. Breast milk and infection. Clin Perinatol (2004) 31(3):501-28. doi:10.1016/j.clp.2004.03.019
Edwards MS, Munoz FM, Baker CJ. Antibodies to type III Group B streptococcal polysaccharide in breast milk. Pediatr Infect Dis J (2004) 23(10):961-3. doi:10.1097/01.inf.0000142333.72511.8c
Lagergård T, Thiringer K, Wassen L, Schneerson R, Trollfors B. Isotype composition of antibodies to Streptococcus Group B type III polysaccharide and to tetanus toxoid in maternal, cord blood sera and in breast milk. Eur J Pediatr (1992) 151(2):98-102. doi:10.1007/BF01958951
WHO. Guidelines on HIV and Infant Feeding 2010: Principles and Recommendations for Infant Feeding in the Context of HIV and a Summary of Evidence. Geneva: WHO Press (2010).
Harris NL, Spoerri I, Schopfer JF, Nembrini C, Merky P, Massacand J, et al. Mechanisms of neonatal mucosal antibody protection. J Immunol (2006) 177(9):6256-62. doi:10.4049/jimmunol.177.9.6256
Heiman HS, Weisman LE. Transplacental or enteral transfer of maternal immunization-induced antibody protects suckling rats from type III Group B streptococcal infection. Pediatr Res (1989) 26(6):629-32. doi:10.1203/00006450-198912000-00023
Le Doare K, Kampmann B. Breast milk and Group B streptococcal infection: vector of transmission or vehicle for protection? Vaccine (2014) 32(26):3128-32. doi:10.1016/j.vaccine.2014.04.020
Le Doare K, Jarju S, Darboe S, Warburton F, Gorringe A, Heath PT, et al. Risk factors for Group B Streptococcus colonisation and disease in Gambian women and their infants. J Infect (2016) 72(3):283-94. doi:10.1016/j.jinf.2015.12.014
Doran KS, Nizet V. Molecular pathogenesis of neonatal Group B streptococcal infection: no longer in its infancy. Mol Microbiol (2004) 54(1):23-31. doi:10.1111/j.1365-2958.2004.04266.x
Levy O. Innate immunity of the newborn: basic mechanisms and clinical correlates. Nat Rev Immunol (2007) 7(5):379-90. doi:10.1038/nri2075
European Collaborative Study. Levels and patterns of neutrophil cell counts over the first 8 years of life in children of HIV-1-infected mothers. AIDS (2004) 18(15):2009-17.
Le Chenadec J, Mayaux M-J, Guihenneuc-Jouyaux C, Blanche S, Group EPFS. Perinatal antiretroviral treatment and hematopoiesis in HIV-uninfected infants. AIDS (2003) 17(14):2053-61. doi:10.1097/00002030-200309260-00006
Pacheco SE, McIntosh K, Lu M, Mofenson LM, Diaz C, Foca M, et al. Effect of perinatal antiretroviral drug exposure on hematologic values in HIV-uninfected children: an analysis of the women and infants transmission study. J Infect Dis (2006) 194(8):1089-97. doi:10.1086/507645
Puliti M, Uematsu S, Akira S, Bistoni F, Tissi L. Toll-like receptor 2 deficiency is associated with enhanced severity of Group B streptococcal disease. Infect Immun (2009) 77(4):1524-31. doi:10.1128/IAI.00965-08
Landwehr-Kenzel S, Henneke P. Interaction of Streptococcus agalactiae and cellular innate immunity in colonization and disease. Front Immunol (2014) 5:519. doi:10.3389/fimmu.2014.00519
Mancuso G, Midiri A, Beninati C, Biondo C, Galbo R, Akira S, et al. Dual role of TLR2 and myeloid differentiation factor 88 in a mouse model of invasive Group B streptococcal disease. J Immunol (2004) 172(10):6324-9. doi:10.4049/jimmunol.172.10.6324
Berner R, Welter P, Brandis M. Cytokine expression of cord and adult blood mononuclear cells in response to Streptococcus agalactiae. Pediatr Res (2002) 51(3):304-9. doi:10.1203/00006450-200203000-00007
Afran L, Garcia Knight M, Nduati E, Urban BC, Heyderman RS, Rowland-Jones SL. HIV-exposed uninfected children: a growing population with a vulnerable immune system? Clin Exp Immunol (2014) 176(1):11-22. doi:10.1111/cei.12251
Velilla PA, Montoya CJ, Hoyos A, Moreno ME, Chougnet C, Rugeles MT. Effect of intrauterine HIV-1 exposure on the frequency and function of uninfected newborns' dendritic cells. Clin Immunol (2008) 126(3):243-50. doi:10.1016/j.clim.2007.11.004
Reikie BA, Adams RCM, Leligdowicz A, Ho K, Naidoo S, Ruck CE, et al. Altered innate immune development in HIV-exposed uninfected infants. J Acquir Immune Defic Syndr (2014) 66(3):245-55. doi:10.1097/QAI.0000000000000161
Deshmukh SD, Kremer B, Freudenberg M, Bauer S, Golenbock DT, Henneke P. Macrophages recognize streptococci through bacterial single-stranded RNA. EMBO Rep (2011) 12(1):71-6. doi:10.1038/embor.2010.189
Cusumano V, Genovese F, Mancuso G, Carbone M, Fera MT, Teti G. Interleukin-10 protects neonatal mice from lethal Group B streptococcal infection. Infect Immun (1996) 64(7):2850-2.
Andrade EB, Alves J, Madureira P, Oliveira L, Ribeiro A, Cordeiro-da-Silva A, et al. TLR2-induced IL-10 production impairs neutrophil recruitment to infected tissues during neonatal bacterial sepsis. J Immunol (2013) 191(9):4759-68. doi:10.4049/jimmunol.1301752
Hygino J, Lima PG, Renato Filho G, Silva AA, Saramago CS, Andrade RM, et al. Altered immunological reactivity in HIV-1-exposed uninfected neonates. Clin Immunol (2008) 127(3):340-7. doi:10.1016/j.clim.2008.01.020
Heyderman RS, Madhi SA, French N, Cutland C, Ngwira B, Kayambo D, et al. Group B Streptococcus vaccination in pregnant women with or without HIV in Africa: a non-randomised phase 2, open-label, multicentre trial. Lancet Infect Dis (2016) 16(5):546-55. doi:10.1016/S1473-3099(15)00484-3
Shah M, Aziz N, Leva N, Cohan D. Group B Streptococcus colonization by HIV status in pregnant women: prevalence and risk factors. J Womens Health (2011) 20(11):1737-41. doi:10.1089/jwh.2011.2888
Joao EC, Gouvêa MI, Menezes JA, Matos HJ, Cruz MLS, Rodrigues CA, et al. Group B Streptococcus in a cohort of HIV-infected pregnant women: prevalence of colonization, identification and antimicrobial susceptibility profile. Scand J Infect Dis (2011) 43(9):742-6. doi:10.3109/00365548.2011.585178
El Beitune P, Duarte G, Maffei CML, Quintana SM, De Sá Rosa E, Silva ACJ, et al. Group B Streptococcus carriers among HIV-1 infected pregnant women: prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol (2006) 128(1):54-8. doi:10.1016/j.ejogrb.2006.02.017
Mavenyengwa RT, Moyo SR, Nordbø SA. Streptococcus agalactiae colonization and correlation with HIV-1 and HBV seroprevalence in pregnant women from Zimbabwe. Eur J Obstet Gynecol Reprod Biol (2010) 150(1):34-8. doi:10.1016/j.ejogrb.2010.02.021
Matee MI, Massawe FA, Lyamuya EF. Maternal and neonatal colonisation of Group B Streptococcus at Muhimbili National Hospital in Dar es Salaam, Tanzania: prevalence, risk factors and antimicrobial resistance. BMC Public Health (2009) 9(1):437. doi:10.1186/1471-2458-9-437
Heath PT. An update on vaccination against Group B Streptococcus. Expert Rev Vaccines (2011) 10(5):685-94. doi:10.1586/erv.11.61