Abstract
BackgroundIn sub-Saharan African countries Epstein Barr virus (EBV) infection occurs in early childhood. We aim to investigate the factors associated with EBV acquisition and the impact of EBV infection on the humoral response to HBV vaccination in infants born from HIV-positive, antiretroviral-treated mothers in Malawi.MethodsA total of 149 HIV-exposed infants were included in this longitudinal study. EBV anti-VCA IgG were measured using an ELISA assay. The EBV seroconversion was correlated with the maternal viro-immunological conditions, with infant growth and immunological vulnerability, and with the humoral response to the HBV vaccine.ResultsNo infant was EBV-positive at 6 months (n. 52 tested). More than a third of infants (49/115 or 42.6 %) on study beyond 6 months seroconverted at 12 months. At 24 months, out of 66 tested infants, only 13 remained EBV-uninfected, while 53 (80.3 %) acquired EBV infection, rising the total proportion of EBV seroconversion to 88.7 % (102/115 infants). EBV seroconversion was significantly associated with a low maternal educational status but had no impact on infant growth or vulnerability to infections. Reduced HBsAb levels and accelerated waning of antibodies were associated with early EBV seroconversion.ConclusionsWe found a heterogeneous timing of acquisition of EBV with the majority of infants born from HIV + mothers acquiring infection after 6 months. Anti-HBs levels were lower and appeared to wane faster in infants acquiring EBV infection.
Highlights
In sub-Saharan African countries Epstein Barr virus (EBV) infection occurs in early childhood
Early EBV infection in HIV-exposed children can concur in determining immune system dysfunctions; exploratory studies have indicated that early infection with EBV in infants is associated with reduced antibody responses to polysaccharides and measles vaccines [7], while others have shown that EBV latency can accelerate the decay of immune response to measles and rubella vaccines [8]
In this study we evaluated EBV infection in a cohort of Malawian HIV-exposed but uninfected (HEU) infants with the following objectives: (a) to identify the potential factors associated with EBV infection acquisition in infants at 1 and 2 years of age, (b) to determine the possible impact of EBV infection on infants growth and vulnerability to infections and (c) to explore the impact of EBV infection on the magnitude of the humoral immune response following HBV vaccination and the persistence of protective titres over time
Summary
In sub-Saharan African countries Epstein Barr virus (EBV) infection occurs in early childhood. We aim to investigate the factors associated with EBV acquisition and the impact of EBV infection on the humoral response to HBV vaccination in infants born from HIV-positive, antiretroviral-treated mothers in Malawi. The Epstein-Barr virus (EBV) is ubiquitous in human populations, it establishes a lifelong latency, with intermittent reactivation, and generally, limited clinical symptoms. Limited is the information on the impact of early EBV infection on the magnitude and persistence of immune response to Hepatitis B (HBV) vaccination. Hepatitis B is highly prevalent in Malawi: in the general population HBsAg seroprevalence is estimated at about 7.9 % [9], and a similar rate has been observed in the HIV-positive population [10]. The vaccination schedule does not include the child birth dose
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