Invasive Amebiasis as an Emerging Parasitic Disease in Patients with Human Immunodeficiency Virus Type 1 Infection in Taiwan

Abstract

Background Whether risk of invasive amebiasis due to Entamoeba histolytica is higher among human immunodeficiency virus (HIV)–infected persons than uninfected persons remains unclear, although intestinal colonization by Entamoeba dispar is common among men who have sex with men . Our objective was to determine the prevalence of invasive amebiasis and intestinal colonization by E histolytica and E dispar in HIV-infected persons and uninfected controls. Methods We assessed the prevalence of invasive amebiasis by case review of 951 HIV-infected persons and by serologic studies of 634 of the 951 HIV-infected persons, 429 uninfected controls with gastrointestinal symptoms, and 178 uninfected healthy controls using indirect hemagglutination antibody assay. We assessed the rate of intestinal colonization by E histolytica and E dispar by fecal antigen and polymerase chain reaction tests in 332 asymptomatic HIV- infected persons and 144 of the 178 uninfected healthy controls. Results Forty-nine (5.2%) of 951 HIV-infected persons had 51 episodes of invasive amebiasis. A high indirect hemagglutination antibody titer was detected in 39( 6.2%) of 634 HIV-infected persons compared with 10 (2.3%) of 429 uninfected controls with gastrointestinal symptoms and 0 of 178 uninfected healthy controls (P<.001). Stool specimens from 40 (12.1%) of 332 HIV- infected persons and 2( 1.4%) of 144 uninfected healthy controls were positive for E histolytica or E dispar antigen (P<.001). Ten (25.0%) of the 40 antigen-positive stool specimens from HIV-infected persons contained E histolytica. Conclusion Persons infected with HIV in Taiwan are at increased risk for invasive amebiasis and exhibit a relatively high frequency of elevated antibody titers and intestinal colonization with E histolytica. Author Affiliations: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine (Drs Hung, Hsieh, Chen , and Chang); Department of Parasitology, National Taiwan University College of Medicine (Drs Hung and Su); Center for Disease Control, Department of Health, Taiwan (Dr Deng and Mr Hsiao); and Division of Biostatistics and Bioinformatics, National Health Research Institutes (Dr Hsiao), Taipei, Taiwan.