Streptococcus pneumoniae colonization among patients with human immunodeficiency virus-1 who had received 23-valent polysaccharide pneumococcal vaccine

Background and purpose: To evaluate the impact of 23-valent polysaccharide pneumococcal vaccine on Streptococcus pneumoniae colonization in the upper airway of patients with human immunodeficiency virus (HIV)-1 in Taiwan. Methods: 302 HIV-infected patients aged 15 years or older underwent swab cultures of the posterior pharynx and tonsils for S. pneumoniae between June 1, 2000 and June 30, 2002. 198 patients (65.6%) had received 23-valent polysaccharide pneumococcal vaccine with a median interval of 420 days (range, 27-634 days) before cultures were performed. Clinical characteristics and laboratory findings were analyzed to determine the factors associated with S. pneumoniae colonization in the upper airway. Results: Twenty patients (6.6%) had colonization with S. pneumoniae: 15 of 198 patients (7.6%) who had received 23-valent polysaccharide pneumococcal vaccine and 5 of 104 patients (4.8%) who had not received the vaccine (p = 0.37). According to the multivariate analysis, smoking was the only factor that was statistically significantly associated with S. pneumoniae colonization (adjusted odds ratio, 4.03; 95% confidence interval, 1.04-15.64; p = 0.04); pneumococcal vaccination was not statistically significantly associated with S. pneumoniae colonization. Conclusions: Among HIV-infected patients, smoking was the only factor significantly associated with a higher prevalence of upper airway colonization by S. pneumoniae. As previous receipt of 23-valent polysaccharide pneumococcal vaccine was not associated with a lower prevalence of S. pneumoniae colonization, a better vaccination strategy, in addition to smoking cessation, may be needed to reduce S. pneumoniae colonization in HIV-infected adults.