No evidence of prolonged enterovirus excretion in HIV‐seropositive patients

Abstract

SummaryMutations frequently occur in oral poliovirus vaccine (OPV) strains upon replication in the human intestine. These strains occasionally revert to being neurovirulent. The more prolonged the excretion of OPV, the higher the risk of reversion. OPV strains can be secreted for several months in humans presenting humoral immune system deficiencies. The duration of excretion of OPV strains or other enteroviruses in individuals infected with the human immunodeficiency virus (HIV) is unknown. We investigated whether HIV infection, which is very prevalent in the Central African Republic, causes prolonged excretion of enteroviruses and, in particular, of OPV strains in adults. We studied 28 HIVinfected adults living with children who were immunized with OPV during national immunization days (NIDs). Blood samples were collected to confirm HIV status and to evaluate immunodeficiency before the NIDs. Stool samples for enterovirus isolation were also collected before the NIDs, between the two rounds of immunization and 2, 4 and 6 months after the second round of immunization. No poliovirus was isolated from any stool sample. Eight enteroviruses were isolated from eight adults (maximum one strain per patient). Enteroviruses were not more frequently isolated from severely immunodeficient patients. Thus, HIV-infected adults do not appear to be at high risk of infection with OPV strains and the excretion of enteroviruses (and thus of polioviruses) does not seem to be prolonged in HIV-infected adults.keywords oral poliovirus vaccine, human immunodeficiency virus, adults, excretion

Limited duration of vaccine poliovirus and other enterovirus excretion among human immunodeficiency virus infected children in Kenya

“…One study described a case of chronic enterovirus meningoencephalitis in an HIV-infected adult, successfully treated with pleconaril [13]. However, other studies found no evidence of prolonged or more severe enterovirus infections among HIV-infected persons [14,15]. Also, available data do not support the increased risk or severity of wild or vaccine-associated poliomyelitis in HIV-infected individuals.…”

The Role of Prolonged Viral Gastrointestinal Infections in the Development of Immunodeficiency-Related Enteropathy

“…Nonetheless, others did not find prolonged VDPV shedding in a cohort of 38 X-linked agammaglobulinemia (XLA) patients [78], 16 PID patients [79], and 346 IgG-or IgA-deficient patients [77], suggesting that these chronic carriers are incidental cases. In HIV-positive individuals, who predominantly have T cell defects but may develop humoral deficits, prolonged VDPV shedding (>6 months) has not been reported [67][68][69][80][81][82], except for one study in which person-to-person transmission however could not be excluded [68,69].…”

Vaccine Poliovirus Shedding and Immune Response to Oral Polio Vaccine in HIV-Infected and -Uninfected Zimbabwean Infants

“…Vaccine poliovirus was detected in 5.6% versus 2.1% of the samples from HIV-infected versus -uninfected children, but no poliovirus shedding was seen beyond 4 weeks. In 2 studies, the stools of 28 and 419 HIV-infected adults who were living with or nearby to children immunized with OPV during national immunization days in the Central African Republic and Cote d'Ivoire were found to contain no detectable poliovirus [26,27]. A cross-sectional study in Guatemala examined the stools of 94 HIV-infected children (median age, 3.6 years) who had not received OPV for at least 6 months along with 101 HIV-infected adults and also found no detectable poliovirus [16].…”