Lo Yi-Chun, Ji Dar-Der, Hung Chien-Ching
Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Taipei, Taiwan; Department of Tropical Medicine, National Yang-Ming University, Taipei, Taiwan.
PLoS Negl Trop Dis. 2014 Oct 9;8(10):e3222. doi: 10.1371/journal.pntd.0003222. eCollection 2014 Oct.
Sexually 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.
The 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.
Of 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/SIGNIFICANCE: Prevalent 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.
在男男性行为者（MSM）中，性传播溶组织内阿米巴感染（EHI）已得到越来越多的认识。我们利用国家疾病监测系统（NDSS）来确定EHI成年患者中HIV诊断的流行率和发病率，并确定相关因素。
NDSS通过医生报告和公共卫生访谈收集病例患者的人口统计学、临床和行为特征。EHI通过聚合酶链反应检测、组织病理学或伴有肝脓肿记录的血清学检查得以确诊。我们将NDSS数据库相链接，以确定2006 - 2013年期间确诊EHI的非住院台湾成年人中HIV诊断的流行率和发病率。采用Cox比例风险分析来确定相关因素。
在确诊EHI的非住院成年人中，我们在524名男性中的210名（40%）和59名女性中的1名（1.7%）中发现了HIV诊断流行病例，在314名男性中的71名（23%）中发现了HIV诊断新发病例。MSM分别占男性HIV诊断流行病例和新发病例的183例（87%）和64例（90%）。从2006 - 2009年到2010 - 2013年，在患有EHI的男性中，HIV诊断的流行率从32%上升至45%（P = 0.001），而HIV诊断的发病率从每100人年5.4例增至11.3例（P = 0.001）。HIV诊断新发病例与年龄较小、居住在大都市地区、住院治疗、既往梅毒病史以及发病前有口交、肛交或口肛交行为独立相关。
结论/意义：在台湾成年男性中，越来越多地发现HIV诊断流行病例和新发病例，这些病例优先影响年轻的城市MSM。建议针对HIV流行与性传播EHI之间的相互作用开展监测和降低风险干预措施。
