title: Prevalent and incident HIV diagnoses among Entamoeba histolytica-infected adult males: a changing epidemiology associated with sexual transmission--Taiwan, 2006-2013.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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
  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.
authors.affiliation: 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.
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Lo
authors.affiliation: Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Taipei, Taiwan; Department of Tropical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Dar-Der
authors.initials: DD
authors.lastname: Ji
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan.
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
mesh_terms: D000328:Adult; D004749:Entamoebiasis / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D013587:Syphilis / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors