Increased risk for Entamoeba histolytica infection and invasiva amebiasis in HIV seropositive men who have sex with men in Taiwan

Background: Incidence of Entomoeba histolytica infection clinical manisfestation and treatment response of invansive amebiasis (IA) in HIV-infected patients have rarely been investigated before. Methodology/Principal Findings: At the National Talwan University Hospital, medical records of HIV-infected patients who received a diagnosis of IA between 1994 and 2005 were reviewed. The incidence of amebiasis was investigated in serial blood and stool samples from stool samples containing E. histolytica were analyzed by PCR, sequenced, and compared. Sbrty-four (5.8%) of 1,109 HIV-infected patients had 67 episodes of IA, and 89.19% of them were men having sex with men (MSM). The CD4 count at diagnosis of IA was significantly higher than that of the whole cohort (215 cells/μ1. vs. 96 cells/μ1.) Forty episodes (59.7%) were liver abscesses, 52 (77.6%) colitis, and 25 (37.3%) both liver abscesses and colitis. Fever resolved after 3.5 days of metronidazole therapy (range, 1-11 days). None of the patients died. The incidence of E. histolyrica infection in MSM was higher than that in other risk groups assessed by serological assays (1.99 per 100 person-years [PY] vs. 0 per 100 PY; p<0.0001) and amebic antigens assays (3.16 per 100 PY vs. 0.68 per 100 PY; p=0.12). In multiple logistic regression analysis, only MSM was significantly associated with acquisition of E. histolytica infection (adjusted odds ratio, 14. 809; person-to-person transmission. Conclusion/Significance: HIV-infected MSM were at significantly higher risk of ameblasis than patients from other risk groups. Despite immunosuppression, amebic liver abscesses and colitis responded favorably to treatment. ? 2008 Hung et al.