ChrysanShiou-Haur Liang1, Yi-Chun Lo2, Hsi-Hsun Lin1, Sui-Yuan Chang3, Mao-Yuan Chen2, Szu-Min Hsieh2, Wang-Huei Sheng2, Hsin-Yun Sun2, Chien-Ching Hung2, Shan-Chwen Chang2
1Section of Infectious Disease, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung County; 2Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei; and 3Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
Received: April 12, 2007 Revised: June 10, 2007 Accepted: July 31, 2007
Corresponding author: Dr. Chien-Ching Hung, Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei 100, Taiwan. E-mail:
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Background and Purpose: The seroprevalence of viral hepatitis and spectrum of infectious complications among human immunodeficiency virus (HIV)-infected injection drug users (IDUs) remains unclear in Taiwan, although there has been a significant increase in the prevalence of HIV infection among IDUs in the last 2 to 3 years.
Methods: The medical records of HIV-infected IDUs who sought medical care at a referral hospital for HIV care from June 1994 to December 2006 were retrospectively reviewed. A standardized case record form was used to collect demographic, clinical, laboratory and microbiologic data.
Results: During the 12-year study period, a total of 102 HIV-infected IDUs with a median age of 39.5 years (range, 19 to 73 years) sought HIV care at the referral hospital. The male-to-female case ratio was 6 and males were significantly older than females (39.5 vs 28 years, p<0.001). The overall median CD4+ cell count and plasma HIV RNA load by reverse transcriptase-polymerase chain reaction at enrollment were 374 cells/μL and 4.45 log10 copies/mL, respectively. The CD4+ cell count of HIV-infected IDUs enrolled after year 2003 was significantly higher than those enrolled before 2003 (438 vs 23 cells/μL, p<0.001). The seroprevalence of hepatitis C virus (86.6% overall) increased over time, while that of hepatitis B virus decreased in the patients born after 1984, when nationwide hepatitis B vaccination was started in Taiwan. Gram-positive bacteria were causative for 69.7% of the 33 bacteremic episodes, and Staphylococcus aureus was the leading pathogen (16 episodes), with methicillin-sensitive S. aureus accounting for 11 bacteremic episodes (33.3%). The most common bacterial infection was infective endocarditis. Tuberculosis occurred more frequently in men, and extrapulmonary tuberculosis was more common than pulmonary tuberculosis and was associated with a lower CD4+ count.
Conclusions: Bacteremia, infective endocarditis and tuberculosis were the three most common patterns of infection among HIV-infected IDUs who sought medical care at a referral hospital; and methicillin-sensitive S. aureus was the most common etiology of bacteremia. The high seroprevalence of hepatitis B and C and subsequent hepatic complications may present a future challenge to the health care system.
Key words: Endocarditis; Hepatitis, viral, human; HIV infection; Substance abuse, intravenous; Tuberculosis
J Microbiol Immunol Infect. 2008;41:200-208.
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