The Unfinished Agenda: Pursuing Durable Protection Against Pneumococcal Disease in People Living with Human Immunodeficiency Virus
,
Abstract
Background: The syndemic of the human immunodeficiency virus and Streptococcus pneumoniae infections remains a significant global health challenge. Despite effective antiretroviral therapy, people living with the human immunodeficiency virus face a 20- to 100-fold higher risk of invasive pneumococcal disease due to persistent, multifaceted immunodeficiency affecting both innate and adaptive immunity. This includes dysfunction of alveolar macrophages and neutrophils, compromised mucosal barriers, depletion of CD4+ T-cells particularly T-follicular helper cells and B-cell dysregulation, creating a perfect storm for invasive infection. The evolution from polysaccharide to conjugate vaccines represents a major advancement. Pneumococcal conjugate vaccines, by enabling T-cell-dependent responses, generate higher-quality antibodies, robust memory B-cells, and demonstrate superior immunogenicity and effectiveness in people living with the human immunodeficiency virus compared to the 23-valent pneumococcal polysaccharide vaccine. Evidence from immunogenicity studies, observational data, and the herd effects from childhood pneumococcal conjugate vaccines programs confirms that pneumococcal conjugate vaccines significantly reduce vaccine-type pneumococcal disease. However, challenges like serotype replacement, waning immunity, suboptimal response despite antiretroviral therapy, and the aging of the people living the human immunodeficiency virus population impede optimal protection.
Conclusion: While conjugate vaccines have transformed prevention, durable protection against pneumococcal disease in people living with the human immunodeficiency virus remains an unfinished agenda. Future success hinges on developing novel vaccines (e.g., protein-based), optimizing strategies with adjuvants and boosters, defining correlates of protection, and ensuring global equity in vaccine access. A multifaceted approach combining research, clinical innovation, and public health policy is essential to significantly reduce this burden.
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2. Alum EU, Uti DE, Ugwu OP, et al. Toward a cure–Advancing HIV/AIDs treatment modalities beyond antiretroviral therapy: A Review. Medicine 2024; 103(27):e38768.
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5. Garland JM, Mayan H, Kantor R. Treatment of Advanced HIV in the Modern Era. Drugs 2025: 1-27.
6. Maeda H, Morimoto K. Global distribution and characteristics of pneumococcal serotypes in adults. Hum Vaccin Immunother 2025; 21(1):2469424.
7. Narciso AR, Dookie R, Nannapaneni P, et al. Streptococcus pneumoniae epidemiology, pathogenesis and control. Nat Rev Microbiol 2025; 23(4):256-71.
8. Acchioni C, Sandini S, Acchioni M, et al. Co-infections and superinfections between HIV-1 and other human viruses at the cellular level. Pathogens 2024; 13(5):349.
9. Ozisik L. The New Era of Pneumococcal Vaccination in Adults: What Is Next?. Vaccines 2025; 13(5):498.
10. Wan SW, Choe L, Daariin AB, et al. Determinants of pneumococcal vaccination among older adults: A scoping review. Pub Health 2024; 237:245-60.
11. Thong BY, Pawankar R, Park HS, et al. Evaluating immune responses to pneumococcal vaccines. Asia Pac Allergy 2023; 13(3):127-31.
12. Micoli F, Romano MR, Carboni F, et al. Strengths and weaknesses of pneumococcal conjugate vaccines. Glycoconj J 2023; 40(2):135-48.
13. Morais V, Suarez N. Conjugation mechanism for pneumococcal glycoconjugate vaccines: classic and emerging methods. Bioengineering 2022; 9(12):774.
14. Zhao J, Hu G, Huang Y, et al. Polysaccharide conjugate vaccine: A kind of vaccine with great development potential. Chin Chem Lett 2021; 32(4):1331-40.
15. Dunbar SA. Multiplexed suspension array immunoassays for detection of antibodies to pneumococcal polysaccharide and conjugate vaccines. Front Cell Infect Microbiol 2023; 13:1296665.
16. Lynch JP, Zhanel GG. Streptococcus pneumoniae: epidemiology and risk factors, evolution of antimicrobial resistance, and impact of vaccines. Curr Opin Pulm Med 2010; 16(3):217-25.
17. Li L, Ma J, Yu Z, et al. Epidemiological characteristics and antibiotic resistance mechanisms of Streptococcus pneumoniae: An updated review. Microbiol Res 2023; 266:127221.
18. Asai N, Motojima S, Ohkuni Y, et al. Pathophysiological mechanism of non-HIV Pneumocystis jirovecii pneumonia. Respir Investig 2022; 60(4):522-30.
19. Nasr M, Mohammad A, Hor M, et al. Exploring the differences in Pneumocystis pneumonia infection between HIV and non-HIV patients. Cureus 2022; 14(8).
20. Ibrahim A, Chattaraj A, Iqbal Q, et al. Pneumocystis jiroveci pneumonia: a review of management in human immunodeficiency virus (HIV) and non-HIV immunocompromised patients. Avicenna J Med 2023; 13(01):023-34.
21. McDonald EG, Afshar A, Assiri B, et al. Pneumocystis jirovecii pneumonia in people living with HIV: a review. Clin Microbiol Rev 2024; 37(1):e00101-22.
22. Salzer HJ, Schäfer G, Hoenigl M, et al. Clinical, diagnostic, and treatment disparities between HIV-infected and non-HIV-infected immunocompromised patients with Pneumocystis jirovecii pneumonia. Respiration 2018; 96(1):52-65.
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25. Weiser JN, Ferreira DM, Paton JC. Streptococcus pneumoniae: transmission, colonization and invasion. Nat Rev Microbiol 2018; 16(6):355-67.
26. Musher DM, Anderson R, Feldman C. The remarkable history of pneumococcal vaccination: an ongoing challenge. Pneumonia 2022; 14(1):5.
27. Fogsgaard SF, Todaro S, Larsen CS, et al. Reassessing Polysaccharide Responsiveness: Unveiling Limitations of Current Guidelines and Introducing the Polysaccharide Responsiveness Percentile Approach. J Clin Immunol 2025; 45(1):1.
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31. Dagan R, Goldblatt D, Maleckar JR, et al. Reduction of antibody response to an 11-valent pneumococcal vaccine coadministered with a vaccine containing acellular pertussis components. Infect Immun 2004; 72(9):5383-91.
32. Barrett DJ, Ayoub EM. IgG2 subclass restriction of antibody to pneumococcal polysaccharides. Clin Exp Immunol 1986; 63(1):127-34.
33. 33. Pichichero ME. Protein carriers of conjugate vaccines: characteristics, development, and clinical trials. Hum Vaccin Immunother 2013; 9(12):2505-23.
34. Anttila M, Voutilainen M, Jäntti V, et al. Contribution of serotype-specific IgG concentration, IgG subclasses and relative antibody avidity to opsonophagocytic activity against Streptococcus pneumoniae. Clin Exp Immunol 1999; 118(3):402-7.
35. Goldblatt D, Southern J, Andrews N, et al. The immunogenicity of 7-valent pneumococcal conjugate vaccine versus 23-valent polysaccharide vaccine in adults aged 50-80 years. Clin Infect Dis 2009; 49(9): 1318-25.
36. Oliveira GS, Oliveira ML, Miyaji EN, et al. Pneumococcal vaccines: past findings, present work, and future strategies. Vaccines 2021; 9(11):1338.
37. Briles DE, Paton JC, Mukerji R, et al. Pneumococcal vaccines. Microbiol Spectr 2019; 7(6).
38. Crum-Cianflone NF, Huppler Hullsiek K, Roediger M, et al. A randomized clinical trial comparing revaccination with pneumococcal conjugate vaccine to polysaccharide vaccine among HIV-infected adults. J Infect Dis 2010; 202(7):1114-25.
39. Glesby MJ, Watson W, Brinson C, et al. Immunogenicity and safety of 13-valent pneumococcal conjugate vaccine in HIV-infected adults previously vaccinated with pneumococcal polysaccharide vaccine. J Infect Dis 2015; 212(1):18-27.
40. Zou X, He J, Zheng J, et al. Evaluation of effectiveness, safety and cost-benefit of the 23–valent pneumococcal capsular polysaccharide vaccine for HIV-Infected patients. Vaccine 2022; 40(1):37-42.
41. Von Gottberg A, Kleynhans J, De Gouveia L, et al. Long-term effect of pneumococcal conjugate vaccines on invasive pneumococcal disease incidence among people of all ages from national, active, laboratory-based surveillance in South Africa, 2005–19: a cohort observational study. Lancet Glob Health 2024; 12(9):e1470-84.
42. Lekhuleni C, Ndlangisa K, Gladstone RA, et al. Impact of pneumococcal conjugate vaccines on invasive pneumococcal disease-causing lineages among South African children. Nat Commun 2024; 15(1):8401.
43. Hanquet G, Krizova P, Dalby T, et al. Serotype replacement after introduction of 10-valent and 13-valent pneumococcal conjugate vaccines in 10 countries, Europe. Emerg Infect Dis 2022; 28(1):127.
44. Gallagher KE, Odiwour F, Bottomley C, et al. Serotype-specific pneumococcal invasiveness: a global meta-analysis of paired estimates of disease incidence and carriage prevalence. medRxiv 2025.
45. Farrar JL, Childs L, Ouattara M, et al. Systematic review and meta-analysis of the efficacy and effectiveness of pneumococcal vaccines in adults. Pathogens 2023; 12(5):732.
46. Alem K. Prevalence of bacterial pneumonia among HIV-Seropositive patients in East Africa. Cogent Med 2021; 8(1):2015883.
47. El‐Beyrouty C, Buckler R, Mitchell M, et al. Pneumococcal vaccination—A literature review and practice guideline update. Pharmacother 2022; 42(9):724-40.
48. Masomian M, Ahmad Z, Ti Gew L, et al. Development of next generation Streptococcus pneumoniae vaccines conferring broad protection. Vaccines 2020; 8(1):132.
49. Scelfo C, Menzella F, Fontana M, et al. Pneumonia and invasive pneumococcal diseases: the role of pneumococcal conjugate vaccine in the era of multi-drug resistance. Vaccines 2021; 9(5):420.
50. Feemster K, Hausdorff WP, Banniettis N, et al. Implications of cross-reactivity and cross-protection for pneumococcal vaccine development. Vaccines 2024; 12(9):974.
51. Daigle D, Morales G, Hayford K, et al. Recommendations for pneumococcal vaccination of at-risk children: a global overview (2022–2024). Vaccine 2025; 63:127669.
52. Feldman C, Dlamini S, Richards GA, et al. A comprehensive overview of pneumococcal vaccination recommendations for adults in South Africa, 2022. J Thorac Dis 2022; 14(10):4150.
53. Olwagen CP, Izu A, Van der Merwe L, et al. Single priming and a booster dose of 10-valent and 13-valent pneumococcal conjugate vaccine (PCV) maintains suppression of vaccine serotype colonization in South African children at 3, 4, and 5 years of age: a single-centre, open-labelled, randomized trial. Expert Rev Vaccines 2024; 23(1):1011-9.
54. Cripps AW, Folaranmi T, Johnson KD, et al. Immunogenicity following revaccination or sequential vaccination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) in older adults and those at increased risk of pneumococcal disease: a review of the literature. Expert Rev Vaccines 2021; 20(3):257-67.
55. Lansbury L, Lim B, McKeever TM, et al. Non-invasive pneumococcal pneumonia due to vaccine serotypes: a systematic review and meta-analysis. EClinicalMedicine 2022; 44.
56. Watkins ER, Kalizang’Oma A, Gori A, et al. Factors affecting antimicrobial resistance in Streptococcus pneumoniae following vaccination introduction. Trends Microbiol 2022; 30(12):1135-45.
57. Lagousi T, Papadatou I, Strempas P, et al. Pneumococcal immunization strategies for high-risk pediatric populations worldwide: one size does not fit all. Vaccines 2021; 9(12):1390.
58. Du QQ, Shi W, Yu D, et al. Epidemiology of non-vaccine serotypes of Streptococcus pneumoniae before and after universal administration of pneumococcal conjugate vaccines. Hum Vaccin Immunother 2021; 17(12):5628-37.
59. Loe-Sack-Sioe GE, de Vos DW, Visser LG, et al. Pneumococcal vaccine hyporesponsiveness in people living with HIV: A narrative review of immunological mechanisms and insights from minimally invasive lymph node sampling. Hum Vaccin Immunother 2025; 21(1):2503602.
60. Teixeira R, Kossyvaki V, Galvez P, et al. Pneumococcal serotype evolution and burden in European adults in the last decade: a systematic review. Microorganisms 2023; 11(6):1376.
61. Duke JA, Avci FY. Emerging vaccine strategies against the incessant pneumococcal disease. npj Vaccines 2023; 8(1):122.
62. Villar-Álvarez F, de la Rosa-Carrillo D, Fariñas-Guerrero F, et al. Immunosenescence, immune fitness and vaccination schedule in the adult respiratory patient. Open Respir Arch 2022; 4(3):100181.
63. He XY, Wang XW, Li S, et al. Immunosenescence and its related comorbidities in older people living with HIV. Infect Dis Immun 2025; 5(1):44-55.
64. Chauvin M, Sauce D. Mechanisms of immune aging in HIV. Clin Sci 2022; 136(1):61-80.
65. Blanco JR, Negredo E, Bernal E, et al. Impact of HIV infection on aging and immune status. Expert Rev Anti Infect Ther 2021; 19(6):719-31.
66. Mody A, Sohn AH, Iwuji C, et al. HIV epidemiology, prevention, treatment, and implementation strategies for public health. Lancet 2024; 403(10425):471-92.
67. Parveen S, Subramanian K. Emerging roles of extracellular vesicles in pneumococcal infections: Immunomodulators to potential novel vaccine candidates. Front Cell Infect Microbiol 2022; 12:836070.
68. Li S, Liang H, Zhao SH, et al. Recent progress in pneumococcal protein vaccines. Front Immunol 2023; 14:1278346.
69. Scott NR, Mann B, Tuomanen EI, et al. Multi-valent protein hybrid pneumococcal vaccines: a strategy for the next generation of vaccines. Vaccines 2021; 9(3):209.
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2. Alum EU, Uti DE, Ugwu OP, et al. Toward a cure–Advancing HIV/AIDs treatment modalities beyond antiretroviral therapy: A Review. Medicine 2024; 103(27):e38768.
3. Xiaoqing H, Min L, Yaokai C. Advance of common AIDS related opportunistic infections. Electron J Emerg Infect Dis; 10(2):81.
4. Clemente T, Papaioannu-Borjesson R, Castagna A, et al. Addressing late HIV presentation: the current knowledge and unmet needs. Expert Rev Anti Infect Ther 2025:1-7.
5. Garland JM, Mayan H, Kantor R. Treatment of Advanced HIV in the Modern Era. Drugs 2025: 1-27.
6. Maeda H, Morimoto K. Global distribution and characteristics of pneumococcal serotypes in adults. Hum Vaccin Immunother 2025; 21(1):2469424.
7. Narciso AR, Dookie R, Nannapaneni P, et al. Streptococcus pneumoniae epidemiology, pathogenesis and control. Nat Rev Microbiol 2025; 23(4):256-71.
8. Acchioni C, Sandini S, Acchioni M, et al. Co-infections and superinfections between HIV-1 and other human viruses at the cellular level. Pathogens 2024; 13(5):349.
9. Ozisik L. The New Era of Pneumococcal Vaccination in Adults: What Is Next?. Vaccines 2025; 13(5):498.
10. Wan SW, Choe L, Daariin AB, et al. Determinants of pneumococcal vaccination among older adults: A scoping review. Pub Health 2024; 237:245-60.
11. Thong BY, Pawankar R, Park HS, et al. Evaluating immune responses to pneumococcal vaccines. Asia Pac Allergy 2023; 13(3):127-31.
12. Micoli F, Romano MR, Carboni F, et al. Strengths and weaknesses of pneumococcal conjugate vaccines. Glycoconj J 2023; 40(2):135-48.
13. Morais V, Suarez N. Conjugation mechanism for pneumococcal glycoconjugate vaccines: classic and emerging methods. Bioengineering 2022; 9(12):774.
14. Zhao J, Hu G, Huang Y, et al. Polysaccharide conjugate vaccine: A kind of vaccine with great development potential. Chin Chem Lett 2021; 32(4):1331-40.
15. Dunbar SA. Multiplexed suspension array immunoassays for detection of antibodies to pneumococcal polysaccharide and conjugate vaccines. Front Cell Infect Microbiol 2023; 13:1296665.
16. Lynch JP, Zhanel GG. Streptococcus pneumoniae: epidemiology and risk factors, evolution of antimicrobial resistance, and impact of vaccines. Curr Opin Pulm Med 2010; 16(3):217-25.
17. Li L, Ma J, Yu Z, et al. Epidemiological characteristics and antibiotic resistance mechanisms of Streptococcus pneumoniae: An updated review. Microbiol Res 2023; 266:127221.
18. Asai N, Motojima S, Ohkuni Y, et al. Pathophysiological mechanism of non-HIV Pneumocystis jirovecii pneumonia. Respir Investig 2022; 60(4):522-30.
19. Nasr M, Mohammad A, Hor M, et al. Exploring the differences in Pneumocystis pneumonia infection between HIV and non-HIV patients. Cureus 2022; 14(8).
20. Ibrahim A, Chattaraj A, Iqbal Q, et al. Pneumocystis jiroveci pneumonia: a review of management in human immunodeficiency virus (HIV) and non-HIV immunocompromised patients. Avicenna J Med 2023; 13(01):023-34.
21. McDonald EG, Afshar A, Assiri B, et al. Pneumocystis jirovecii pneumonia in people living with HIV: a review. Clin Microbiol Rev 2024; 37(1):e00101-22.
22. Salzer HJ, Schäfer G, Hoenigl M, et al. Clinical, diagnostic, and treatment disparities between HIV-infected and non-HIV-infected immunocompromised patients with Pneumocystis jirovecii pneumonia. Respiration 2018; 96(1):52-65.
23. Feldman C, Anderson R. Epidemiology, virulence factors and management of the pneumococcus. F1000Res 2016; 5:2320.
24. Brooks LR, Mias GI. Streptococcus pneumoniae’s virulence and host immunity: aging, diagnostics, and prevention. Front Immunol 2018; 9:1366.
25. Weiser JN, Ferreira DM, Paton JC. Streptococcus pneumoniae: transmission, colonization and invasion. Nat Rev Microbiol 2018; 16(6):355-67.
26. Musher DM, Anderson R, Feldman C. The remarkable history of pneumococcal vaccination: an ongoing challenge. Pneumonia 2022; 14(1):5.
27. Fogsgaard SF, Todaro S, Larsen CS, et al. Reassessing Polysaccharide Responsiveness: Unveiling Limitations of Current Guidelines and Introducing the Polysaccharide Responsiveness Percentile Approach. J Clin Immunol 2025; 45(1):1.
28. Liang X, Zhou J, Wang M, et al. Progress and prospect of polysaccharides as adjuvants in vaccine development. Virulence 2024; 15(1):2435373.
29. Gurbanov R. 2021. Synthetic Polysaccharide‐Based Vaccines: Progress and Achievements. In: Polysaccharides: Properties and Applications. Scrivener Publishing LLC, pp 683-99.
30. Sikjær MG, Pedersen AA, Wik MS, et al. Vaccine effectiveness of the pneumococcal polysaccharide and conjugated vaccines in elderly and high-risk populations in preventing invasive pneumococcal disease: a systematic search and meta-analysis. Eur Clin Respir J 2023; 10(1):2168354.
31. Dagan R, Goldblatt D, Maleckar JR, et al. Reduction of antibody response to an 11-valent pneumococcal vaccine coadministered with a vaccine containing acellular pertussis components. Infect Immun 2004; 72(9):5383-91.
32. Barrett DJ, Ayoub EM. IgG2 subclass restriction of antibody to pneumococcal polysaccharides. Clin Exp Immunol 1986; 63(1):127-34.
33. 33. Pichichero ME. Protein carriers of conjugate vaccines: characteristics, development, and clinical trials. Hum Vaccin Immunother 2013; 9(12):2505-23.
34. Anttila M, Voutilainen M, Jäntti V, et al. Contribution of serotype-specific IgG concentration, IgG subclasses and relative antibody avidity to opsonophagocytic activity against Streptococcus pneumoniae. Clin Exp Immunol 1999; 118(3):402-7.
35. Goldblatt D, Southern J, Andrews N, et al. The immunogenicity of 7-valent pneumococcal conjugate vaccine versus 23-valent polysaccharide vaccine in adults aged 50-80 years. Clin Infect Dis 2009; 49(9): 1318-25.
36. Oliveira GS, Oliveira ML, Miyaji EN, et al. Pneumococcal vaccines: past findings, present work, and future strategies. Vaccines 2021; 9(11):1338.
37. Briles DE, Paton JC, Mukerji R, et al. Pneumococcal vaccines. Microbiol Spectr 2019; 7(6).
38. Crum-Cianflone NF, Huppler Hullsiek K, Roediger M, et al. A randomized clinical trial comparing revaccination with pneumococcal conjugate vaccine to polysaccharide vaccine among HIV-infected adults. J Infect Dis 2010; 202(7):1114-25.
39. Glesby MJ, Watson W, Brinson C, et al. Immunogenicity and safety of 13-valent pneumococcal conjugate vaccine in HIV-infected adults previously vaccinated with pneumococcal polysaccharide vaccine. J Infect Dis 2015; 212(1):18-27.
40. Zou X, He J, Zheng J, et al. Evaluation of effectiveness, safety and cost-benefit of the 23–valent pneumococcal capsular polysaccharide vaccine for HIV-Infected patients. Vaccine 2022; 40(1):37-42.
41. Von Gottberg A, Kleynhans J, De Gouveia L, et al. Long-term effect of pneumococcal conjugate vaccines on invasive pneumococcal disease incidence among people of all ages from national, active, laboratory-based surveillance in South Africa, 2005–19: a cohort observational study. Lancet Glob Health 2024; 12(9):e1470-84.
42. Lekhuleni C, Ndlangisa K, Gladstone RA, et al. Impact of pneumococcal conjugate vaccines on invasive pneumococcal disease-causing lineages among South African children. Nat Commun 2024; 15(1):8401.
43. Hanquet G, Krizova P, Dalby T, et al. Serotype replacement after introduction of 10-valent and 13-valent pneumococcal conjugate vaccines in 10 countries, Europe. Emerg Infect Dis 2022; 28(1):127.
44. Gallagher KE, Odiwour F, Bottomley C, et al. Serotype-specific pneumococcal invasiveness: a global meta-analysis of paired estimates of disease incidence and carriage prevalence. medRxiv 2025.
45. Farrar JL, Childs L, Ouattara M, et al. Systematic review and meta-analysis of the efficacy and effectiveness of pneumococcal vaccines in adults. Pathogens 2023; 12(5):732.
46. Alem K. Prevalence of bacterial pneumonia among HIV-Seropositive patients in East Africa. Cogent Med 2021; 8(1):2015883.
47. El‐Beyrouty C, Buckler R, Mitchell M, et al. Pneumococcal vaccination—A literature review and practice guideline update. Pharmacother 2022; 42(9):724-40.
48. Masomian M, Ahmad Z, Ti Gew L, et al. Development of next generation Streptococcus pneumoniae vaccines conferring broad protection. Vaccines 2020; 8(1):132.
49. Scelfo C, Menzella F, Fontana M, et al. Pneumonia and invasive pneumococcal diseases: the role of pneumococcal conjugate vaccine in the era of multi-drug resistance. Vaccines 2021; 9(5):420.
50. Feemster K, Hausdorff WP, Banniettis N, et al. Implications of cross-reactivity and cross-protection for pneumococcal vaccine development. Vaccines 2024; 12(9):974.
51. Daigle D, Morales G, Hayford K, et al. Recommendations for pneumococcal vaccination of at-risk children: a global overview (2022–2024). Vaccine 2025; 63:127669.
52. Feldman C, Dlamini S, Richards GA, et al. A comprehensive overview of pneumococcal vaccination recommendations for adults in South Africa, 2022. J Thorac Dis 2022; 14(10):4150.
53. Olwagen CP, Izu A, Van der Merwe L, et al. Single priming and a booster dose of 10-valent and 13-valent pneumococcal conjugate vaccine (PCV) maintains suppression of vaccine serotype colonization in South African children at 3, 4, and 5 years of age: a single-centre, open-labelled, randomized trial. Expert Rev Vaccines 2024; 23(1):1011-9.
54. Cripps AW, Folaranmi T, Johnson KD, et al. Immunogenicity following revaccination or sequential vaccination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) in older adults and those at increased risk of pneumococcal disease: a review of the literature. Expert Rev Vaccines 2021; 20(3):257-67.
55. Lansbury L, Lim B, McKeever TM, et al. Non-invasive pneumococcal pneumonia due to vaccine serotypes: a systematic review and meta-analysis. EClinicalMedicine 2022; 44.
56. Watkins ER, Kalizang’Oma A, Gori A, et al. Factors affecting antimicrobial resistance in Streptococcus pneumoniae following vaccination introduction. Trends Microbiol 2022; 30(12):1135-45.
57. Lagousi T, Papadatou I, Strempas P, et al. Pneumococcal immunization strategies for high-risk pediatric populations worldwide: one size does not fit all. Vaccines 2021; 9(12):1390.
58. Du QQ, Shi W, Yu D, et al. Epidemiology of non-vaccine serotypes of Streptococcus pneumoniae before and after universal administration of pneumococcal conjugate vaccines. Hum Vaccin Immunother 2021; 17(12):5628-37.
59. Loe-Sack-Sioe GE, de Vos DW, Visser LG, et al. Pneumococcal vaccine hyporesponsiveness in people living with HIV: A narrative review of immunological mechanisms and insights from minimally invasive lymph node sampling. Hum Vaccin Immunother 2025; 21(1):2503602.
60. Teixeira R, Kossyvaki V, Galvez P, et al. Pneumococcal serotype evolution and burden in European adults in the last decade: a systematic review. Microorganisms 2023; 11(6):1376.
61. Duke JA, Avci FY. Emerging vaccine strategies against the incessant pneumococcal disease. npj Vaccines 2023; 8(1):122.
62. Villar-Álvarez F, de la Rosa-Carrillo D, Fariñas-Guerrero F, et al. Immunosenescence, immune fitness and vaccination schedule in the adult respiratory patient. Open Respir Arch 2022; 4(3):100181.
63. He XY, Wang XW, Li S, et al. Immunosenescence and its related comorbidities in older people living with HIV. Infect Dis Immun 2025; 5(1):44-55.
64. Chauvin M, Sauce D. Mechanisms of immune aging in HIV. Clin Sci 2022; 136(1):61-80.
65. Blanco JR, Negredo E, Bernal E, et al. Impact of HIV infection on aging and immune status. Expert Rev Anti Infect Ther 2021; 19(6):719-31.
66. Mody A, Sohn AH, Iwuji C, et al. HIV epidemiology, prevention, treatment, and implementation strategies for public health. Lancet 2024; 403(10425):471-92.
67. Parveen S, Subramanian K. Emerging roles of extracellular vesicles in pneumococcal infections: Immunomodulators to potential novel vaccine candidates. Front Cell Infect Microbiol 2022; 12:836070.
68. Li S, Liang H, Zhao SH, et al. Recent progress in pneumococcal protein vaccines. Front Immunol 2023; 14:1278346.
69. Scott NR, Mann B, Tuomanen EI, et al. Multi-valent protein hybrid pneumococcal vaccines: a strategy for the next generation of vaccines. Vaccines 2021; 9(3):209.
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| Files | ||
| Issue | Vol 14 No 1 (2026) | |
| Section | Review Articles | |
| Keywords | ||
| Human immunodeficiency virus Immunocompromised Invasive pneumococcal disease Pneumococcal conjugate vaccine Streptococcus pneumoniae. | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Fekri M, Abednejad A. The Unfinished Agenda: Pursuing Durable Protection Against Pneumococcal Disease in People Living with Human Immunodeficiency Virus. J Med Bacteriol. 2026;14(1):51-61.
