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Between March and October, 2018, 1248 people living with HIV completed questionnaire interviews for cancer screening, of whom 46.9% (n = 585) completed free-of-charge cancer screening. Time constraint (50.1%) was the most common reason provided for refusal to participate in cancer screening. None of the participants were diagnosed with any of the four cancers.

Background/purpose: Early initiation of antiretroviral therapy (ART) reduces the risks for serious infections and mortality. We aimed to assess the outcomes of initiating ART among HIV-positive Taiwanese according to the CD4 cut-off values by the WHO recommendations. Methods: We reviewed medical records of patients with newly diagnosed HIV infection between 2004 and 2015 and 3 groups of patients were defined according to the timing of ART initiation based on CD4 count recommended by WHO: Group 1 between 2004 and 2009; Group 2 between 2010 and 2012; and Group 3 between 2013 and 2015. The primary outcome was all-cause mortality. All patients were followed until 2 years after the last patient was included in each group. Results: Of 2022 patients included, the mortality rate was 18.28, 14.01, and 9.10 deaths per 1000 person-years of follow-up (PYFU) in Groups 1, 2, and 3, respectively. In multivariable Cox regression analysis, factors associated with mortality were age (per 1-year increase, adjusted hazard ratio [AHR], 1.06; 95% CI, 1.05–1.08), presence of AIDS-defining disease at HIV diagnosis (AHR, 4.81; 95% CI, 2.99–7.74), solid-organ malignancy (AHR, 3.10; 95% CI, 1.86–5.18), and initiation of ART (AHR, 0.09; 95% CI, 0.05–0.16). By competing risk regression model for non-AIDS-related death, the AHR for Group 3 versus Group 1 was 0.27 (95% CI, 0.09–0.80). Conclusions: While continued efforts are needed to improve early diagnosis and linkage to care, initiation of cART improved survival among HIV-positive patients in Taiwan according to the increasing CD4 cut-off values that were recommended by the WHO.

Background: Cardiovascular disease (CVD) is an emerging cause of morbidity and mortality among HIV-positive patients receiving successful combination antiretroviral therapy, but their CVD risk has been rarely investigated in Asia–Pacific region. We aimed to assess the CVD risk of HIV-positive Taiwanese outpatients. Methods: We did cross-sectional questionnaire interviews to collect information of HIV-positive Taiwanese patients aged 40–79 at the HIV clinics of a medical center from 1 March to 31 August, 2017. The Framingham Risk Score (FRS), Atherosclerotic Cardiovascular Disease (ASCVD) risk score and Data-Collection on Adverse effects of Anti-HIV Drugs (D:A:D) risk score were used to estimate their CVD risk. Results: Of the screened 1251 patients, 1006 (80.4%) with complete data to assess their CVD risk were included for analyses. The prevalence of patients aged 40–75 and with a high CVD risk was 30.6% by FRS, 3.7% by D:A:D (R) risk score, and 22.2% by ASCVD risk score. In multiple logistic regression, older age, current smoking, higher systolic blood pressure, and higher triglyceride and fasting glucose levels were independently associated with the ASCVD risk score ≥7.5%. If current smokers aged 55–59 had stopped smoking, the proportions of them with a 10-year CVD risk of ≥10% by FRS and ≥7.5% by ASCVD risk score would have decreased by 35.3% and 20.0%, respectively. Conclusions: Higher CVD risk estimates among HIV-positive Taiwanese aged 40–75 were associated with an older age, current smoking, higher systolic blood pressure, hypertriglyceridemia, and hyperglycemia. Smoking cessation could potentially lead to significant decreases of CVD risk. Keywords: Comorbidity, Framingham equation, Atherosclerotic cardiovascular disease (ASCVD), Data-collection on adverse effects of anti-HIV drugs (D:A:D), Antiretroviral therapy

Despite provision of free-of-charge human immunodeficiency virus (HIV) care and antiretroviral therapy in Taiwan, a substantial proportion of patients experience late HIV diagnosis. We investigated the risk factors for late HIV diagnosis in Taiwan. Methods: Structured interviews were conducted among newly diagnosed HIV-infected patients to collect data on demographics, socio-behavioral variables and clinical profiles within 1 year preceding HIV diagnosis from August 2006 to July 2008. Multivariate analysis was performed to identify factors associated with missed opportunities for HIV testing and late HIV diagnosis (< 200 CD4 cells/μL). Results: Among 227 newly diagnosed HIV-infected patients, 107 (47%) had late HIV diagnosis. Patients who had first positive tests for HIV at voluntary testing sites [odds ratio (OR): 0.22; 95% confidence interval (CI): 0.10–0.50], regular sexual partners at HIV diagnosis (OR: 0.30; 95% CI: 0.14–0.68), and unprotected sex in the preceding 3 months (OR: 0.16; 95% CI: 0.07–0.34) were less likely to have late HIV diagnosis. Missed opportunities for HIV testing after seeking medical attention occurred in 47 patients (20.7%) and were more common in patients with late HIV diagnosis than in those who received an earlier diagnosis (23.0% vs. 15.8%, p = 0.03). Patients with late HIV diagnosis were more likely than their counterparts to have received a diagnosis of seborrheic dermatitis (7.4% vs. 0.8%, p = 0.02) and community-acquired pneumonia (5% vs. 0%, p = 0.02), for which HIV testing was not offered by the health care providers. Conclusion: Late HIV diagnosis is not uncommon in Taiwan. Regular risk assessment and provision of routine HIV testing in medical encounters and increase of accessibility to voluntary HIV testing could facilitate earlier diagnosis of HIV infection.

Parvovirus B19 is associated with erythema infectiosum in children or arthralgia and arthritis in adults. The virus is relatively conserved and nucleotide identity is expected in viruses that are epidemiologically related. Here, we describe the first cluster of parvovirus infection among hospital staff documented in Taiwan. Methods: Active surveillance was conducted in coronary care units (CCUs) at a 2200-bed teaching hospital for 1 month in 2007. A case defined clinically as occurring in a patient or staff in CCUs with new onset of fever or rash. Serum was tested for parvovirus B19 IgM and IgG by immunoblotting and DNA by nested polymerase chain reaction. When viremia was detected, nucleotide sequences were analyzed and compared with those of two clinical isolates. The attack rate was defined as the cumulative incidence of acute infection in CCU staff and patients during the study period. Results: Among 57 staff and 15 patients, five nurses met the clinical case definition. Three had acute infection as demonstrated by viral DNA and IgM. The attack rate was 5.3% for the staff and zero for patients. Seroprevalence rate was lower in staff than in patients (26.3% vs. 53.3%). The isolates collected from three cases were highly similar to a community isolate, and they varied with each other by 2-6 nucleotides. The isolate collected from a nurse was identical to that from her friend 3 weeks apart and was concordant with mutual transmission. A sequence with 45 nucleotide variations was identified from a staff member with chronic infection who was negative for IgM and had only weak IgG anti-VP1 reaction with immunoblotting. We did not find any patient as the source of infection. Conclusion: We identified a cluster of parvovirus infection that was caused by three circulating strains which did not support the hypothesis of transmission of a single strain in CCUs.

Human immunodeficiency virus (HIV)-infected patients are more susceptible to tuberculosis (TB), which might be the initial presentation of HIV infection. This study assessed the frequency and results of HIV testing among patients diagnosed with TB at a university hospital from 2000 to 2006. Methods: Surveillance data for all reported TB cases from 2000 to 2006 were reviewed to identify patients with unknown HIV serostatus who received HIV testing when TB was diagnosed. Trends in HIV testing among TB patients were examined, and factors associated with HIV infection were analyzed. Results: From 2000 to 2006, 3643 patients were diagnosed with TB, and 49 with HIV infection prior to TB diagnosis were excluded. Of the 3594 patients with unknown HIV status before TB diagnosis, 1035 (28.8%) were offered HIV testing. There was an increasing trend of providing HIV testing to TB patients that ranged from 16.1% to 43.7% (p < 0.001), and the overall prevalence of HIV infection among TB patients was 5.6% (95% CI, 4.3–7.1%) of those tested. Compared with TB patients without HIV infection, those with HIV infection were more likely to be aged < 50 years [adjusted odds ratio (aOR), 8.0; 95% CI, 4.4–14.6), male (aOR, 7.1; 95% CI, 3.0–16.9), and present with extrapulmonary TB (aOR, 2.8; 95% CI, 1.7–4.6). Conclusion: The frequency of HIV testing among TB patients remained low at the university hospital providing TB and HIV care in Taiwan from 2000 to 2006. Among those tested for HIV infection, age < 50 years, male gender and presentation of extrapulmonary TB were associated with HIV infection.

Since the late 1980s, the Taiwanese government has provided all HIV-infected citizens with free access to antiretroviral therapy. Recently, there is controversy as to whether or not free access to expensive highly active antiretroviral therapy (HAART) should be continued for HIV-infected patients. This study aimed to evaluate the cost-effectiveness of HAART therapy. Methods: HAART-associated improvement in survival was obtained by analyzing the follow-up data of all HIV-positive patients identified during April 1984 to March 1997 (pre-HAART era) and May 1997 to April 2003 (HAART era) in Taiwan. Data on quality of life in HIV-positive patients was obtained from a cross-sectional survey of 224 patients using standard gamble method and World Health Organization Quality of Life-BREF instrument. Information regarding the cost of HAART was obtained from the National Health Insurance (NHI). Results: In 2000, the average annual NHI expenditure on HAART per HIV-positive patient receiving HAART was NT$210,018 (US$6177, at an exchange rate of 34.0 NT$/US$). In the AIDS group, the cost was NT$176,441 (US$5189) per life year gained and NT$241,700 (US$7109) per quality-adjusted life year gained. For non-AIDS patients, the corresponding costs were NT$226,156 (US$6652) and NT$332,582 (US$9782), respectively. These estimates have not yet included the additional cost savings from HAART-associated reduction in hospitalization and use of antimicrobial agents for opportunistic infections, and the additional life years gained from the reduction in HIV transmission under the universal availability of HAART Conclusion: HAART for HIV infection is cost-effective, especially when the societal and epidemiologic factors are considered. We recommend that the policy of providing free HAART to all HIV-infected citizens be continued.