艾滋病毒状况和伤寒风险和iNTS:系统性审查和元分析
Peter I Johnston1, Wankumbu Chisala2, Adam Hinchcliffe3
1Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi; School of Medicine and Population Health, The University of Sheffield, UK and the Florey Institute of Infection, The University of Sheffield, UK.
The Journal of infection
|August 9, 2025
概括
与目前的疫苗接种建议相反,感染艾滋病毒 (PLHIV) 的人可能患伤寒的风险较低. 晚期的艾滋病毒感染,特别是低CD4计数,似乎对伤寒有保护作用,但增加了侵袭性非伤寒沙门氏菌疾病的风险.
科学领域:
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
- 公共卫生 公共卫生
背景情况:
- 世界卫生组织 (WHO) 建议优先对艾滋病毒感染者 (PLHIV) 进行伤寒疫苗接种.
- 然而,现有证据表明,PLHIV患者的伤寒发烧风险增加是不一致的.
- 这项研究调查了艾滋病毒感染与血液培养确认的伤寒发烧风险之间的关系.
研究的目的:
- 为了评估艾滋病毒感染是否会改变患有血培确认的伤寒发病的风险.
- 评估艾滋病毒对侵袭性非伤寒型沙门氏菌 (iNTS) 疾病风险的影响.
- 为了告知公众卫生疫苗接种策略的伤寒.
主要方法:
- 在2023年11月30日之前,对四个数据库进行系统的文献搜索.
- 包括报告沙门氏菌Typhi细菌病的研究,并记录了艾滋病毒状况和iNTS细菌病数据.
- 随机效应元分析以汇集几率比率 (ORs) 并根据ART时代,年龄和CD4计数评估效应的修改.
主要成果:
- 分析了17项涉及10,117名PLHIV和53,289名HIV阴性个体的研究.
- 在PLHIV患者中,伤寒发烧的几率较低 (OR0.53),但 iNTS疾病的几率显著更高 (OR4.06).
- 伤寒保护在CD4计数<200细胞/μl的成年人中最为明显,在抗逆转录病毒疗法 (ART) 推出后减少.
结论:
- 先进的艾滋病毒感染可能与降低伤寒发烧的风险有关.
- 在PLHIV中增加iNTS疾病的风险表明灵敏度的真正差异,而不是仅仅改变了临床表现或寻求医疗保健的行为.
- 这些发现表明,需要重新评估世卫组织对PLHIV的伤寒疫苗接种优先级.
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