Abstract

Streptococcus agalactiae (GBS) is the leading cause worldwide of neonatal sepsis. We sought to assess to which extent HIV exposure of neonates is associated with GBS neonatal disease. Furthermore, we assessed to which extent HIV infection in women is associated with maternal rectovaginal GBS carriage, the single most important risk factor for GBS neonatal disease. We searched Pubmed, Embase, and Web of Science for studies assessing the association between neonatal GBS disease and HIV-status of the mother and studies that assessed the association between rectovaginal GBS colonization and HIV status in women. HIV-exposed uninfected neonates were more than twice as likely to have neonatal GBS disease compared to unexposed neonates. HIV-exposed neonates were not at increased risk for early-onset neonatal disease, but were 4.43 times more likely to have late-onset neonatal GBS disease. There was no significant association between HIV infection status and rectovaginal GBS carriage. Public health interventions preventing neonatal GBS disease are urgently needed for the increasing group of HIV-exposed neonates. A framework integrating and explaining our findings highlights opportunities for the clinical practice and global health policy to prevent disease. Well-designed studies should clarify the relation between HIV-status and GBS carriage.

Highlights

  • Streptococcus agalactiae (Group B Streptococcus (GBS)), present in the vagina and/or gastro-intestinal tract of 20 to 30% of pregnant women, is the most common infectious agent identified in case of EOD4 and an important pathogen in LOD5

  • In our meta-analysis of the association between HIV infection and rectovaginal GBS carriage, we found no significant association between HIV infection status and rectovaginal GBS carriage (Fig. 4)

  • Group B streptococci (GBS) are a major cause of neonatal sepsis, which results in one million neonatal deaths every year[1]

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Summary

Introduction

Streptococcus agalactiae (Group B Streptococcus (GBS)), present in the vagina and/or gastro-intestinal tract of 20 to 30% of pregnant women, is the most common infectious agent identified in case of EOD4 and an important pathogen in LOD5. Infants born to HIV-infected mothers have increased rates of infectious morbidity and mortality compared to non-exposed infants, even if they remain HIV-uninfected[16,17]. A possible explanation for these observations might be higher rectovaginal GBS carriage rates in HIV-infected women, as rectovaginal GBS carriage is a major risk factor for GBS neonatal sepsis. The objectives of this systematic review and meta-analysis were to assess to which extent HIV exposure of neonates is associated with GBS neonatal disease and to clarify to which extent HIV infection of women is associated with rectovaginal GBS carriage, a major risk factor for GBS neonatal disease

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