The current state of human immunodeficiency virus infection and antiretroviral care in Taiwan [2]
Journal
AIDS
Journal Volume
14
Journal Issue
11
Pages
1669-1670
Date Issued
2000
Author(s)
Abstract
We read with great interest the correspondence by Weber and colleagues in the December issue of this journal [1]. However, the data estimated by IMS USA, which ranked Taiwan as one of several countries with the lowest access (< 1%) to antiretroviral therapy, was not correct. Because Taiwan is not a member of the World Health Organization, the pattern of epidemiology and the clinical spectrum of HIV infection and the status of antiretroviral care have not been described [2,3] and will be likely to be underestimated. In this report, we would like to describe the HIV epidemiology and the current status of HIV care in Taiwan. The first case of HIV infection and AIDS in Taiwan were diagnosed in 1984 and 1986, respectively [4]. Since then, the number of cases has increased (Fig. 1). In 1987, a committee was organized in order to coordinate HIV/AIDS care and obtain information on the epidemiology of HIV infection in Taiwan. Mandatory HIV screening was then initiated among blood donors, military recruits and inmates. There were 23 hospitals and two venereal disease centres around Taiwan that were designated for providing both inpatient and outpatient HIV care and voluntary or anonymous HIV testing. As of 31 December 1999, a total of 2439 patients infected with HIV-1 had been detected, 863 (35.4%) of them having AIDS.Fig. 1.: The change in case numbers of HIV infection and AIDS in Taiwan, 1984–1999. □ HIV; ▪ AIDS.The overall seroprevalence of HIV infection in Taiwan was 12.3 per 100 000. The HIV seroprevalence among blood donors, military recruits and inmates was 1.6 per 100 000, 3.0 per 100 000, and 13.5 per 100 000, respectively, whereas that of HIV infection detected at the 25 designated hospitals and venereal disease centres was 83.0 per 100 000. A survey of HIV infection conducted among commercial female sex workers between 1993 and 1996 revealed a seroprevalence of 0.4%[5]. Among the 2439 patients, 2251 were men with a male-to-female ratio of 12.0. More than 80% (82.4%) of them were between 20 and 49 years of age. The modes of transmission for HIV infection were heterosexual (41.3%), homosexual (28.0%), bisexual (16.1%), intravenous drug use (2.1%), transfusion (2.6%), and perinatal (0.2%). The route of transmission was not clear in 228 patients (9.3%). Among the 62 HIV-infected patients who had acquired the infection through transfusion, 52 were haemophiliacs who had received contaminated blood products. No HIV-2 case had ever been detected. HIV-1 subtypes B and E were the most common subtypes. An analysis of blood specimens collected between 1993 and 1996 showed that 63.2% of the HIV-1 isolates were HIV-1 subtype B and 30.6% were subtype E [6]. Patients with HIV infection have been provided with access to free medical care, on both an inpatient and outpatient basis, at the 23 designated hospitals and two venereal disease centres. Antiretroviral therapy (zidovudine, didanosine, zalcitabine) has been provided free to all patients at any stage of HIV infection since 1990. Protease inhibitors, stavudine, and lamivudine were not available until April 1997, after which time highly active antiretroviral therapy (HAART) was administered to patients who decided to receive antiretroviral therapy. Efavirenz and nevirapine were introduced into Taiwan in mid-1999. The clinical spectrum of AIDS in Taiwan was similar to that described in Western countries, although the incidence of individual opportunistic diseases differed [7]. For example, the incidence of tuberculosis (24.6%) had been high in patients with advanced HIV infection [8], and that of an endemic fungal infection (Penicillium marneffei infection) was increasing [9]. As of 31 December 1999, a cumulative case number of 1284 patients (52.6%) had ever received or were receiving antiretroviral therapy; 550 patients (22.1%) had died and 476 died of HIV-related complications. With the initiation of HAART and increased experience in the management of HIV-related complications, we also found that morbidity and mortality rates declined in a cohort of 309 HIV-infected patients, most of whom were at the advanced stage of HIV infection [7]. It is estimated that one in every four new HIV infections occurred in the Asia-Pacific region, and this region has become the new epicentre of HIV infection by the year 2000 [2,3]. The current patterns of epidemiology of HIV infection and the status of antiretroviral care differ among the countries in this region. Although HAART has been shown to reduce the morbidity and mortality of patients with HIV infection in Western countries, the cost of providing such a standard of care is prohibitively high and most of the less developed countries in the Asia-Pacific region can not afford it. In contrast to the higher seroprevalence in countries of southeast Asia and India, our data showed that the seroprevalence of HIV infection has been low in Taiwan, although the case numbers have been on the increase, which necessitates continuing caution in the near future. In contrast to the estimate made by IMS USA, which ranked Taiwan as one of the countries having the lowest access to antiretroviral therapy, we found that more than 50% of Taiwanese patients with HIV infection had received or were receiving antiretroviral therapy. Chien-Ching Hungab Hong-Jen Changc Mao-Yuan Chena Kung-Chieh Yehc Szu-Min Hsieha Chi-Yen Chuanga
SDGs
Other Subjects
antiretrovirus agent; didanosine; efavirenz; lamivudine; nevirapine; stavudine; zalcitabine; zidovudine; adult; blood donor; blood transfusion; epidemiological data; female; human; Human immunodeficiency virus 2; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; intravenous drug abuse; letter; major clinical study; male; opportunistic infection; Penicillium marneffei; priority journal; prisoner; screening test; seroprevalence; sexual behavior; soldier; Taiwan; tuberculosis; vertical transmission; virus transmission
Publisher
Lippincott Williams and Wilkins
Type
letter