High Propensity for Multidrug-Resistant Pneumococcal Shedding Among Adults Living With HIV on Stable Antiretroviral Therapy in Malawi
Bibliographic record
Abstract
Abstract Background People living with human immunodeficiency virus (HIV; PLHIV) on antiretroviral therapy (ART) are still at risk of pneumococcal disease and have over 2-fold higher pneumococcal carriage prevalence than HIV-uninfected (HIV−) adults). Carriage is a risk factor for pneumococcal disease, antimicrobial resistance (AMR) emergence, and transmission. Therefore, we tested whether the high prevalence of pneumococcal carriage in PLHIV on ART is associated with increased bacterial density, shedding, and AMR. Methods We recruited asymptomatic PLHIV on ART for >1 year (PLHIV-ART>1y) and HIV− adults. Nasopharyngeal swab samples were collected on days 3, 7, 14, 21, and 28, followed by monthly collections for 12 months, while shedding samples were collected on days 3, 21, and 28. Peripheral blood samples were collected on day 3 to measure CD4 cell count and HIV viral load. Pneumococcal carriage density and shedding were assessed using standard bacterial culture, multiple carriage was detected using whole-plate sweep sequencing, and AMR profiling was conducted using disk diffusion and Etest. Results PLHIV-ART>1y had a higher propensity for high-density carriage (adjusted odds ratio, 1.67 [95% confidence interval (CI), 1.07–2.60]; P = .02). Moreover, PLHIV-ART>1y are more likely to shed pneumococci than HIV− adults (adjusted odds ratio, 2.52 [95% CI, 1.06–6.00]; P = .04), with carriage density identified as an important risk factor for shedding (3.35 [1.55–7.24]; P = .002). Aerosol shed isolates from PLHIV-ART>1y were mostly multidrug resistant (18 of 29 [ 62%; 95% CI, 48%–77%]). Conclusions These findings indicate that PLHIV-ART>1y remain at high risk of pneumococcal disease and could also be an important reservoir for shedding multidrug-resistant pneumococci.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".