title: Antibodies against pneumococcal capsular polysaccharide in Malawian HIV-positive mothers and their HIV-exposed uninfected children.
abstract: Background HIV-exposed uninfected children have a higher risk of infection and mortality compared to HIV-unexposed children and the reasons for this vulnerability are still under investigation.
  
  
  OBJECTIVE
  This study aimed to evaluate the influence of maternal HIV parameters on the passive transfer of anti-pneumococcal capsular polysaccharide (PCP) IgG and to determine whether the concentrations of specific IgG might be related to the morbidity and mortality in HIV-exposed uninfected children. Methods One hundred and twenty-six Malawian HIV-infected pregnant women and their uninfected children were studied. Antiretroviral treatment-naive women started a nevirapine-based triple combination regimen from the third trimester of pregnancy until at least 6 months of exclusive breastfeeding. Mother/child pairs were followed until 2 years after delivery. Plasma anti-PCP IgG titers (in mothers at 26 weeks of gestation and in infants at 1 and 6 months) were determined by an enzyme-linked immunosorbent assay. None of these women and children had received any vaccination against pneumococcal polysaccharides. Results Maternal anti-PCP IgG concentration was independent from viral load (p = 0.848), CD4 count (p = 0.740) and WHO stage (p = 0.450). However, the child/mother ratio of anti-PCP IgG measured at 1 month among infants was significantly reduced in pairs whose mothers had HIV-RNA > 10 000 copies/ml (p = 0.043) and CD4 < 350 cells/μl (p = 0.090) before antiretroviral therapy (ART). No clear associations between anti-PCP IgG and respiratory-related deaths were found, but respiratory infection episodes were more frequent among children with lower anti-PCP IgG ratio (p = 0.046). Conclusion This study indicates that HIV pre-ART conditions in mothers may influence the rate of specific immunoglobulins transfer, increasing infants vulnerability to respiratory infections.
authors.affiliation: a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Baroncelli
authors.affiliation: a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Clementina Maria
authors.initials: CM
authors.lastname: Galluzzo
authors.affiliation: b Department of Biomedicine and Prevention , University of Rome Tor Vergata , Rome , Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Mancinelli
authors.affiliation: a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Andreotti
authors.affiliation: c DREAM Program , Community of S. Egidio , Blantyre , Malawi.
authors.forename: Haswell
authors.initials: H
authors.lastname: Jere
authors.affiliation: a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Amici
authors.affiliation: d LUMSA University , Rome , Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Marazzi
authors.affiliation: a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Vella
authors.affiliation: b Department of Biomedicine and Prevention , University of Rome Tor Vergata , Rome , Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Palombi
authors.affiliation: a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Giuliano
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016667:Bacterial Capsules / Q000276:immunology*; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi; D008297:Male; D019829:Nevirapine / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000276:immunology; D011135:Polysaccharides, Bacterial / Q000276:immunology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology*; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D007074:Immunoglobulin G; D011135:Polysaccharides, Bacterial; D019829:Nevirapine
keywords: HIV exposed infants; Malawi; anti-pneumococcal IgG; passive transfer