title: Increased Risk of Group BStreptococcusInvasive Infection in HIV-Exposed but Uninfected Infants: A Review of the Evidence and Possible Mechanisms.
abstract: Group BStreptococcus(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-specific 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.
authors.affiliation: Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium; Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Gosselies, Belgium.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dauby
authors.affiliation: Institute for Medical Immunology, Université Libre de Bruxelles (ULB) , Gosselies , Belgium.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Chamekh
authors.affiliation: Department of Clinical Microbiology, National Reference Centre for Group B Streptococci, CHU Sart-Tilman, Université de Liège (ULg) , Liège , Belgium.
authors.forename: Pierrette
authors.initials: P
authors.lastname: Melin
authors.affiliation: Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; Centre for Infectious Disease and Epidemiologic Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Slogrove
authors.affiliation: Department of Paediatrics, CHU Saint-Pierre, Brussels, Belgium; Université Libre de Bruxelles (ULB), Brussels, Belgium.
authors.forename: Tessa
authors.initials: T
authors.lastname: Goetghebuer
keywords: Group B Streptococcus; HIV; HIV exposed uninfected; breast milk; infant; inflammation; newborn; pregnancy