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Background: Currently, the association between human immunodeficiency virus (HIV) infection and subsequent development of autoimmune hemolytic anemia (AIHA) remains unclear. This nationwide population-based cohort study aimed to determine the association between incident AIHA and HIV infection in Taiwan.Methods: During 2000-2012, we identified people aged ≧15 years living with HIV (PLWH) from the Taiwan Centers for Disease Control HIV Surveillance System. Individuals were considered to be infected with HIV on the basis of positive results of an HIV type 1 Western blot. Age- and sex-matched controls without HIV infection were selected from the Taiwan National Health Insurance Research Database for comparison. All patients were followed until 31 December 2012 and observed for occurrence of AIHA.Results: Of 171468 subjects (19052 PLWH and 152416 controls), 30 (0.02%) had incident AIHA during a mean follow-up of 5.45 years, including 23 PLWH (0.12%) and 7 controls (0.01%). After adjustment for age, sex, and comorbidities, HIV infection was found to be an independent risk factor of incident AIHA (adjusted hazard ratio, 20.9; 95% confidence interval, 8.34-52.3). Moreover, PLWH who were receiving highly active antiretroviral therapy were more likely to develop AIHA than those who were not receiving these drugs (adjusted hazard ratio, 16.2; 95% confidence interval, 3.52-74.2).Conclusions: Our study suggests that HIV infection is an independent risk factor for incident AIHA. [ABSTRACT FROM AUTHOR]

Background: Glycine N-methyltransferase (GNMT) is abundantly expressed in the normal liver but is downregulated in liver cancer tissues. GNMT knockout (Gnmt-/-) mice can spontaneously develop chronic hepatitis, fatty liver, and liver cancer. We previously demonstrated that hepatic GNMT is decreased in high-fat-diet-induced type 2 diabetes mellitus, but its contribution to metabolic syndrome is unclear. Here we show that GNMT modulates key aspects of metabolic syndrome in mice. Methods: Eleven-week-old Gnmt-/- and wild-type (WT) mice with a C57BL/6 genetic background were used in this study. The metabolic defects of GNMT deficiency were measured by glucose and insulin tolerance tests, lipid homeostasis, gluconeogenesis, and insulin signaling. Results: Gnmt-/- mice, especially females, exhibited glucose intolerance and insulin resistance. However, their body fat and lean mass, food and water intakes, and energy expenditure did not differ from those of WT mice. In addition, glucose-stimulated insulin secretion and insulin-stimulated glucagon secretion were normal in the serum and pancreatic islets of Gnmt-/- mice. Importantly, we found that GNMT deficiency increased lipogenesis and triglycerides in the liver. The elevated triglycerides disrupted the ability of insulin to induce Akt and S6 ribosomal protein phosphorylation, and then triggered insulin resistance and gluconeogenesis in female Gnmt-/- mice. Conclusions: Our data indicate that hepatic GNMT regulates lipid and glucose homeostasis, and provide insight into the development of insulin resistance through modulating the PI3K/Akt pathway. [ABSTRACT FROM AUTHOR]

Folic acid exerts both anti-inflammatory and antifibrotic effects. Glycine N-methyltransferase (GNMT), the major folic acid-binding protein in the liver, is a crucial enzyme that regulates the cellular methylation process by maintaining S-adenosylmethionine levels. However, as yet neither the therapeutic effects of folic acid in renal fibrosis nor whether GNMT is involved in these folic acid-associated mechanisms has been investigated. First, the expression of GNMT was examined in human kidneys with or without obstructive nephropathy. Later, wild-type and GNMT knockout (GNMT−/−) mice were subjected to unilateral ureteral obstruction (UUO) and then treated with either folic acid or vehicle for 14 days. Renal tubular injury, inflammation, fibrosis, and autophagy were evaluated by histological analysis and Western blotting. We observed increased expression of GNMT in humans with obstructive nephropathy. Furthermore, UUO significantly increased the expression of GNMT in mice; in addition, it caused renal injury as well as the development of both hydronephrosis and tubular injury. These were all alleviated by folic acid treatment. In contrast, GNMT−/− mice exhibited exacerbated UUO-induced renal injury, but the protective effect of folic acid was not observed in GNMT−/− mice. We propose a novel role for folic acid in the treatment of renal fibrosis, which indicates that GNMT may be a therapeutic target. [ABSTRACT FROM AUTHOR]

Background/purpose: In the past few years, many new subtypes in hepatitis C virus (HCV) genotype 6 have been identified. The aim of this study was to modify the multiplex real-time polymerase chain reaction (RT-PCR) protocol and use it to determine the HCV subtypes of a group of Taiwanese injection drug users (IDUs).Methods: We used 76 serum specimens collected in northern Taiwan in 2008. Multiplex RT-PCR was used for HCV subtyping among those serum samples having anti-HCV antibodies. Twenty cases were randomly selected for comparison with subtyping results from Inno-LiPa II tests and phylogenetic tree analysis using NS5B sequences.Results: Multiplex RT-PCR assays showed that 60.5% (46/76) of IDUs had single HCV infection. Three out of 76 (3.9%) had double HCV infection (1b/6a, 2a/2b and 2b/6a). Besides this, 27.6% (21/76) had no HCV signal. One IDU had subtype 6n and two had subtype 6w infection. Inno-LiPa II tests misclassified all 6n and 6w cases as 1b subtype.Conclusion: Our modified multiplex RT-PCR protocol can be used to support molecular epidemiological studies and laboratory diagnoses of different HCV subtypes including genotype 6. [ABSTRACT FROM AUTHOR]

Background/purpose: Taiwan experienced a rapid surge in human immunodeficiency virus (HIV) among injection drug users (IDUs) from 2003 to 2005. The male-to-female ratio of HIV cases decreased from 20:1 in 2003 to 6:1 in 2006. This change is primarily due to increasing numbers of female injection drug users in Taiwan. Our primary objective was to identify the risk factors associated with HIV infection among incarcerated female drug users.Methods: A case-control design involved recruitment of all eligible HIV-infected female inmates from all 24 prisons in Taiwan from November to December, 2007. Eligible HIV seronegative controls were chosen within the same prison and matched to the cases by age (within 3 years) and by history of illicit drug use. A subsample of these matches was randomly selected since there were many more eligible controls than HIV-infected cases. An anonymous self-administered questionnaire was completed with assistance from trained research assistants.Results: A total of 114 cases and 149 control participants were recruited, with a response rate of 82% and 54%. Injectable heroin use was significantly greater (p = 0.02) among HIV-infected cases (93.0%) than un-infected controls (84.6%). Compared to seronegative controls, HIV-infected cases were more likely to share drug paraphernalia and have drug-using sexual partners. Multiple logistic regression analysis revealed that the number of imprisonments (between 2-5 times; OR = 5.23), sharing mainly dilutes (OR= 63.47), and sharing dilutes concurrently with needles (OR= 127.33) significantly predicted HIV seroconversion, after controlling for age and years of education.Conclusion: Sharing needles/dilutes and practicing unsafe intercourse with drug-using sexual partners places female drug users at considerable risk. [ABSTRACT FROM AUTHOR]

Objective: We attempted to determine the association between a G/A polymorphism at position 158 of the prostate-specific antigen (PSA) gene and the risk of prostate cancer in Taiwanese men. Materials and Methods: We genotyped 149 prostate cancer patients and 176 healthy controls. Logistic regression was used to estimate the odd ratios (ORs) and confidence intervals (CIs). Results: The G allele was more frequent than the A allele in both cases and in controls. The A allele was not associated with a significantly higher risk of prostate cancer (odds ratio [OR] = 1.17, confidence interval = 0.78-1.76). GA (OR = 1.18) and AA (OR = 1.19) genotypes were not associated with a significantly higher risk of prostate cancer. In an analysis by disease aggressiveness, aggressive disease had a higher OR than that for nonaggressive disease (1.38 vs. 0.77); however, these associations were not statistically significant. Conclusions: No association was found between G/A polymorphism and the risk of prostate cancer. Larger studies are necessary to determine whether the A allele is associated with aggressive prostate cancer. [Copyright &y& Elsevier]

Background/purpose: The seroincidence of human immunodeficiency virus (HIV) in Taiwan has drastically increased since 2004, particularly among injection drug users and prisoners. The major purpose of this study was to explore the prevalence and correlates of psychiatric morbidity among HIV-infected male prisoners.Methods: In 2006, data were collected from all of HIV-infected male prisoners (n = 535) in seven prisons in Taiwan. This collection was performed using a self-administered, anonymous questionnaire in group settings directed by our interviewers. Psychiatric morbidity was measured using the five-item Brief Symptom Rating Scale in 535 participants, which represented an 85% response rate. After excluding incomplete data, 479 participants were included in the analysis.Results: Psychiatric morbidity was present in 46% of participants. Multivariate logistic regression revealed that correlates of the five-item Brief Symptom Rating Scale defined cases included the following: being a recidivist, having poor self-rated health status, and having experienced psychiatric symptoms in one's lifetime (e.g. significant physical pain or discomfort, depression for 2 weeks or longer, serious anxiety or tension, trouble understanding, concentrating, or remembering, and serious thoughts of suicide), with a Nagelkerke R(2) equal to 0.365.Conclusion: Psychiatric morbidity is prevalent among HIV-infected male prisoners. Tailored HIV/AIDS education related to mental health is therefore suggested for inclusion as part of a comprehensive HIV/AIDS training program among incarcerated populations. [ABSTRACT FROM AUTHOR]

Background: The pandemic (H1N1) 2009 influenza emerged in April 2009 and spread rapidly and broadly all over the world. In addition to specific antiviral agents, massive vaccination is thought to be the most effective way of controlling the transmission. To understand the prevaccination status of certain risk groups, this study compared the baseline sero-prevalence of antibodies to the pandemic (H1N1) 2009 influenza virus among hospital staff with different contact risks and that of the general population. Methods: A total of 295 serum samples from hospital staff and 244 control serum samples from people who came for physical check-up (control group) were collected between October 2009 and November 2009 before the massive vaccination campaign. The hospital staff was divided into first-line risk personnel (group 1) and second-line risk personnel (group 2) according to their potential contact risks. Hemagglutination-inhibition (HI) tests were conducted to determine the individual serological status. The seropositive rate (SPR, defined as the proportion with HI titer ≥ 1:40) of antibodies to H1N1 influenza virus and its geometric mean titer (GMT) were calculated and compared among the different groups. Results: The mean ages and sex ratio (% male) of the hospital staff and control groups were 36.9 ± 10.6 years and 52.0 ± 12.6 years, and 24.4% and 57.6%, respectively. The SPR of the antibodies to H1N1 influenza virus of the hospital staff was significantly higher than that of the control group (20.0%vs. 2.9%, p < 0.001). Furthermore, the SPR antibodies to H1N1 influenza virus of group 1 were significantly higher than that of group 2 (30.8%vs. 12.6%, p < 0.001). However, the GMT of antibodies to H1N1 influenza virus of the hospital staff was not significantly different from that of the control group (p = 0.925). Conclusion: The SPR of antibodies against the pandemic (H1N1) 2009 virus in the hospital staff was higher than that in the general population, reflecting a higher contact risk. Prevaccination surveillance of the immune status of different risk groups may help to prioritize which groups should be vaccinated first. [Copyright &y& Elsevier]