Secondly, <40% of the patients had nadir CD4 counts of ≥200 cells/μL, suggesting that most of the vaccine recipients in this study had moderate to severe immunosuppression caused by HIV infection. Therefore, the results may not be generalizable to vaccine recipients whose nadir CD4 cell find more counts are significantly higher. Thirdly, the vaccine schedule consisted of a single dose of 23-valent

PPV, which is different from many other vaccination studies in HIV-infected patients in which booster vaccination was administered 1–2 months after the first dose. The short observation periods of these studies did not allow determination of whether a two-dose vaccination schedule may enhance or prolong immunogenicity to PPV. Lastly, we did not use clinical disease as an endpoint in this serological study. Therefore, we were not able to determine whether the rapid decline of antibody responses is associated with increased risk for invasive pneumococcal infection during the 5-year follow-up period, although we only observed one case of pneumococcal pneumonia among our patients over the 5-year study period (data not shown). In conclusion, our study suggests that, despite continued increases in CD4 cell counts after HAART, the serological responses of HIV-infected patients receiving 23-valent PPV

declined significantly over the 5-year follow-up period, especially in those who had CD4 counts <100 cells/μL at vaccination and who failed to achieve virological suppression. Earlier revaccination may be needed RXDX-106 research buy to maintain better antibody responses in patients with moderate immunosuppression despite HAART. The authors would like to thank the National Science Council, Taiwan for financial support (grants NSC 93-2314-B-002-086 and 94-2314-B-002-14). Conflict of Interest: All authors, none to declare. Table S1. Proportions of HIV-infected patients who developed significant antibody responses to serotypes 14. 19F, and 23F in the 6th month, 1st year, 2nd year, 3rd year, 4th year, and 5th year after receiving 23-valent polysaccharide pneumococcal vaccine. Table S2. Univariate analysis of factors associated Isotretinoin with 2-fold or greater

increase of antibody responses to any serotype in the 1st year following 23-valent polysaccharide pneumococcal vaccination. Table S3. Univariate analysis of factors associated with 2-fold or greater increase of antibody responses to any serotype in the 2nd year following 23-valent polysaccharide pneumococcal vaccination. Table S4. Univariate analysis of factor associated with 2-fold or greater increase of antibody responses to any serotype in the 3rd year following 23-valent polysaccharide pneumococcal vaccination. Table S5. Univariate analysis of factors associated with 2-fold or greater increase of antibody responses to any serotype in the 4th year following 23-valent polysaccharide pneumococcal vaccination. Please note: Wiley-Blackwell are not responsible for the content or functionality of any supporting materials supplied by the authors.