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. 2024 Sep 16;13(9):802.
doi: 10.3390/pathogens13090802.

Respiratory Syncytial Virus among People Living with HIV: Is There a Case for Rolling Out Prophylaxis? A Viewpoint Based on a Systematic Review

André Almeida  1   2 , Raffaele Aliberti  3 , Arianna Aceti  4   5 , Matteo Boattini  6   7
Affiliations

Respiratory Syncytial Virus among People Living with HIV: Is There a Case for Rolling Out Prophylaxis? A Viewpoint Based on a Systematic Review

André Almeida et al. Pathogens. .

Abstract

Respiratory Syncytial Virus (RSV) is responsible for a considerable burden of respiratory disease among children and older adults. Several prophylactic strategies have recently been introduced. We review the available evidence on the interplay between RSV infection and HIV, looking at the specific role of RSV prophylactic strategies in individuals affected by or exposed to HIV. We conducted a systematic review on the association between HIV infection and RSV incidence and severity. We searched in PubMed/MEDLINE for clinical epidemiological studies covering outcomes such as RSV-associated illness, severity, and mortality in individuals affected by or exposed to HIV. A total of 36 studies met the inclusion criteria and were included, the majority conducted in sub-Saharan Africa. There was no compelling evidence suggesting a higher incidence of RSV illness among HIV-infected people. A higher risk of severe disease was consistent among both HIV-positive and HIV-exposed but uninfected (HEU) children. Case fatality rates were also higher for these groups. Evidence on a differing risk among adults was scarce. HIV-positive pregnant women should be given priority for recently approved RSV vaccination, for protection of their newborns. HIV-infected and HEU infants should be considered risk groups for nirsevimab prophylaxis in their first year of life and possibly beyond.

Keywords: human immunodeficiency virus; respiratory syncytial virus; vaccination.

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Conflict of interest statement

A. Almeida has received honoraria for teaching at a post-graduate course that had Pfizer among its sponsors. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) Flowchart of included studies.
Figure 2
Figure 2
Bubble plot representing point estimates of endpoints used in studies covering RSV severity outcomes.
Figure 3
Figure 3
Immunological alterations leading to impaired immunogenicity in people living with HIV (figure created on BioRender.com).
Figure 4
Figure 4
Factors associated with protection of infants following maternal active immunization (figure created on BioRender.com).
See this image and copyright information in PMC

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