Prevalent and Incident HIV Diagnoses among Entamoeba histolytica-Infected Adult Males: A Changing Epidemiology Associated with Sexual Transmission — Taiwan, 2006–2013

Abstract

BackgroundSexually transmitted Entamoeba histolytica infection (EHI) has been increasingly recognized among men who have sex with men (MSM). We used the National Disease Surveillance Systems (NDSS) to identify prevalent and incident HIV diagnoses among adults with EHI and to determine the associated factors.MethodologyThe NDSS collect demographic, clinical, and behavioral characteristics of case patients through physician reports and public health interviews. EHI was confirmed by polymerase-chain-reaction assays, histopathology, or serology with documented liver abscess. We linked NDSS databases to identify prevalent and incident HIV diagnoses among noninstitutionalized Taiwanese adults with confirmed EHI during 2006–2013. Cox proportional-hazards analysis was used to determine associated factors.Principal findingsOf noninstitutionalized adults with EHI, we identified prevalent HIV diagnosis in 210 (40%) of 524 males and one (1.7%) of 59 females, and incident HIV diagnosis in 71 (23%) of 314 males. MSM accounted for 183 (87%) and 64 (90%) of prevalent and incident HIV diagnoses in males, respectively. From 2006–2009 to 2010–2013, the prevalence of HIV diagnosis increased from 32% to 45% (P = 0.001) while the incidence of HIV diagnosis increased from 5.4 to 11.3 per 100 person-years (P = 0.001) among males with EHI. Incident HIV diagnosis was independently associated with a younger age, residing in metropolitan areas, hospitalization, previous syphilis, and engagement in oral, anal, or oral–anal sex before illness onset.Conclusions/significancePrevalent and incident HIV diagnoses were increasingly identified among adult males in Taiwan, preferentially affecting younger urban MSM. Surveillance and risk-reduction interventions are recommended against the interplay of HIV epidemic and sexually transmitted EHI.

Prevalence of Integrase Strand Transfer Inhibitors (INSTI) Resistance Mutations in Taiwan

“…It could be related to transmission of resistant strains among patients with risky behaviors since increasing incidence of HDV, HCV, syphilis, and Entamoeba histolytica have been observed in our MSM population in Taiwan2526272829. Indeed, we identified 3 transmission clusters of subtype B in the phylogenetic analysis of integrase sequences with major mutations (Fig.…”

Epidemiology of Domestically Acquired Amebiasis in Japan, 2000–2013

“…12,13,15,25 In fact, symptomatic female cases associated with heterosexual contact increased during the Figure 2). However, the absolute risk of amebiasis for females appears to be lower, as predominance of male amebiasis cases has been reported consistently from various locations that differ culturally, racially, and socioeconomically, 8,10 and females appear to be less affected by amebiasis (e.g., liver abscess), 26,27 which has also been found in animal studies. 28 Moreover, while a higher proportion of males in their 50s are screened for colon cancer during annual *Cases with specific colonic mucosa lesions, such as erythema, edematous mucosa, erosion, white exudates, and ulcers, but otherwise asymptomatic and reported through National Epidemiological Surveillance of Infectious Diseases, were classified as asymptomatic cases.…”

“…[1][2][3][8][9][10]14,27,28 The specific reason(s) for the observed gender difference in the Japanese surveillance data requires further investigation.…”

“…7 Recent studies have reported that invasive amebiasis is prevalent not only in developing countries due to contaminated food or water, but also in developed areas of east Asia (e.g., China, Japan, Korea, and Taiwan) and Australia as a sexually transmitted infection via oral-anal sexual contact, particularly among men who have sex with men (MSM). [8][9][10] Amebiasis is a nationally notifiable disease in Japan, which is one of the few places, along with Taiwan, to conduct national surveillance for amebiasis. 11 Physicians are required to report all cases of amebiasis to the National Epidemiological Surveillance of Infectious Diseases (NESID) system in Japan within 7 days of case diagnosis.…”

Prevalence of HIV infection and risky sexual practices among adult males with travel-associated Entamoeba histolytica infection in Taiwan, 2006–2013

“…Although epidemiologic features of EHI cases imported through immigration and travel were adequately described in this article, characteristics and associated factors of indigenous EHI cases were not addressed. We have recently described the domestic epidemiology of EHI among Taiwanese adult males during 2006e2013 [2]. HIV-infected males (87% being men who have sex with men [MSM]) have predominated over institutionalized individuals as the major risk groups for indigenous EHI since 2010 and E. histolytica-infected males carried a high incidence of subsequent HIV diagnoses, predominantly affecting urban younger MSM.…”