Interpretation of studies conducted in the HAART era is limited by different durations of and immunological and virological

responses to HAART, different vaccination schedules and short-term observation of antibody responses [23–27]. Whether receipt of HAART may improve antibody responses to 23-valent PPV in HIV-infected patients in long-term follow-up whose CD4 cell counts continue to increase has rarely been investigated. In this 5-year HIF inhibitor longitudinal follow-up study, we aimed to assess antibody responses to 23-valent PPV and to identify factors associated with maintaining antibody responses in HIV-infected patients aged ≥18 years who also received HAART. Between June 2000 and June 2002, 305 HIV-infected patients aged 18 years or older who were followed at the National Taiwan University Hospital and agreed to undergo vaccination were immunized with the 23-valent PPV (Pneumovax® 23; Merck & Co., Inc., Whitehouse Station, NJ, USA) following the recommendations of the US Department of Health and Human Services

(DHHS) guidelines to prevent pneumococcal diseases in HIV-infected patients [13]. Based on their CD4 cell counts within 3 months of pneumococcal vaccination, 169 vaccinees were randomly selected for assessment of antibody responses, and four categories of patients were defined: group 1, CD4<100 cells/μL Selleck MLN0128 (n=35); group 2, CD4 100–199 cells/μL (n=36); group 3, CD4 200–349 cells/μL (n=34); and group 4, CD4≥350 cells/μL (n=64) (Table 1). After receipt of a single 0.5-mL injection of 23-valent PPV, the patients continued routine follow-up at out-patient clinics for antiretroviral therapy and related HIV care and were prospectively followed until

31 December 2007. Sequential blood specimens were collected when they returned for routine determinations of plasma HIV RNA load and CD4 lymphocyte count every 4–6 months. The blood specimens collected over the 5-year study period were stored Farnesyltransferase at −70 °C until determinations of anti-capsular antibody titres were performed. The study was approved by the Institutional Review Board of the hospital, and every patient gave written informed consent. Plasma HIV RNA load was quantified using the Cobas Amplicor HIV-1 Monitor test (Cobas Amplicor version 1.5; Roche Diagnostics Corporation, Indianapolis, IN, USA) with a lower detection limit of 400 copies/mL, and CD4 cell count was determined using FACFlow (BD FACS Calibur; Becton Dickinson, San Jose, CA, USA). The CD4 cell count and plasma HIV RNA load were monitored every 4–6 months. HAART was defined as the combination of at least three antiretroviral agents, consisting of two nucleoside reverse transcriptase inhibitors (NRTIs) plus one protease inhibitor (PI) or one nonnucleoside reverse transcriptase inhibitor (NNRTI); or three NRTIs.