Acute Shigellosis among HIV-infected People in 2015: An Outbreak Investigation

Autor: Yi-Ting Shen, 沈伊庭
Rok vydání: 2017
Druh dokumentu: 學位論文 ; thesis
Popis: 105
Background and purpose: Since February 2015, a suspected cluster of domestically-acquired shigellosis has been identified in Taiwan. Most cases occurred among sexual active males with underlying HIV infection. We aim to characterize this outbreak and identify the risk factors through case-control study. Method: We systematically identified all newly reported HIV-shigellosis cases during January 1, 2015 to December 31, 2015, using national surveillance databases. We analyzed the temporal trend, geographical distribution, demographic characteristics, and status in HIV case management. To identify risk factors, each HIV-shigellosis case was matched to 5 controls (notified HIV patients without shigellosis) individually by age (±5 years), date of HIV diagnosis (±90 days), and residing city/county. We further used telephone interview with structured questionnaire to identify behavioral risk factors of cases and controls. We use logistic regression for statistical analyses. Result: We identified 39 HIV-shigellosis cases, the majority are young, unmarried men who have sex with men (MSM) in metropolitan area. There was no common exposure to food or water. The 39 HIV-shigellosis cases were matched to 195 control HIV patients. We successfully interviewed 20 cases and 60 controls, after obtaining informed consent. Multiple logistic regression analyses identified following risk factors: loss to follow-up in HIV case management (adjusted odds ratio [aOR]: 7.45, 95% CI: 1.68-32.93), recent HIV viral load ≥400 copies/mL (aOR: 2.86, 95% CI: 1.08-7.53), past syphilis (aOR: 2.73, 95% CI: 1.05-7.15), past amoebiasis (aOR: 9.43, 95% CI: 1.81-49.06）, oral-anal sexual contact (aOR, 5.70, 95% CI: 1.03-31.58), use of RUSH during sexual encounters (aOR: 6.34, 95% CI: 1.32-30.52), use of amphetamine during sexual encounters (aOR: 9.95, 95% CI: 1.97-50.42). Conclusion: The acute shigellosis outbreak spread sexually via oral-anal contact. Chemosex with use of RUSH or amphetamine, and loss to follow-up in HIV care, are additional risk factors. To control the outbreak, risk of shigellosis should be part of routine sex education for sexually active MSM. Physicians should be aware of the association between acute shigellosis and sexual behaviors carrying high HIV risk. HIV testing and counseling is advised for all persons with newly diagnosed acute shigellosis.
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