{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T12:09:59Z","timestamp":1784117399505,"version":"3.55.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,2,15]],"date-time":"2020-02-15T00:00:00Z","timestamp":1581724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,15]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The majority of pediatric human immunodeficiency virus (HIV) cases in Africa reflect maternal-to-child transmission. HIV exposed but uninfected (HEU) children have increased rates of morbidity and mortality when compared to HIV unexposed and uninfected (HUU) children. The mechanisms behind these unexpected trends are only partially understood but could be explained by the differences in the immune response to infections triggered by an altered immune system state.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Using quantitative reverse transcription polymerase chain reaction, we compared the nasopharyngeal carriage prevalence and density of Streptococcus pneumoniae (SP) and Pneumocystis jirovecii (PJ) between children living with HIV and HEU or HUU cases (pneumonia) and controls (without pneumonia).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The cohort included 1154 children (555 cases and 599 matched controls). The SP carriage prevalence rates were similar between cases and controls. Among SP carriers with pneumonia, carriage density was increased among children living with HIV, versus HEU or HUU children (15.8, 4.7, and 3.6 \u00d7 105 copies\/mL, respectively). The rate of PJ carriage was significantly higher among children living with HIV than among HEU and HUU children (31%, 15%, and 10%, respectively; P\u2005&lt;\u2005.05), as was carriage density (63.9, 20.9, and 4.8 \u00d7 103 copies\/mL, respectively; P\u2005&lt;\u2005.05).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Carriage prevalences and densities for SP and PJ show different kinetics in terms of their relationship with HIV exposure and clinical status, particularly for Pneumocystis jirovecii. This supports the theory that the increased morbidity and mortality observed among HEU children may reflect deficits not just in humoral immunity but in cell-mediated immunity as well.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/cid\/ciaa164","type":"journal-article","created":{"date-parts":[[2020,3,10]],"date-time":"2020-03-10T16:41:53Z","timestamp":1583858513000},"page":"1033-1041","source":"Crossref","is-referenced-by-count":2,"title":["A Tale of 2 Pneumos: The Impact of Human Immunodeficiency Virus Exposure or Infection Status on Pediatric Nasopharyngeal Carriage of\n Streptococcus pneumoniae<\/i>\n and\n Pneumocystis jiroveci<\/i>\n : A Nested Case Control Analysis From the Pneumonia Etiology Research In Child Health Study"],"prefix":"10.1093","volume":"72","author":[{"given":"Ingrid Y","family":"Camelo","sequence":"first","affiliation":[{"name":"Pediatric Infectious Diseases Department, Boston University Medical Center, Boston University School of Medicine , Boston, Massachusetts,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence M","family":"Mwananyanda","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health , Boston, Massachusetts,","place":["USA"]},{"name":"Right to Care Zambia , Lusaka,","place":["Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald M","family":"Thea","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health , Boston, Massachusetts,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Seidenberg","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of New Mexico , Albuquerque, New Mexico,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health , Boston, Massachusetts,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Department of Medicine, Boston University Medical Center , Boston, Massachusetts,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,2,15]]},"reference":[{"key":"2026071507260542900_CIT0001","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S1473-3099(13)70363-3","article-title":"Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges","volume":"14","author":"Lowenthal","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"2026071507260542900_CIT0002","volume-title":"Programmatic update: use of antiretroviral drugs for treating 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