Yen Chin Chen

Curvilinear relationship between depression and unprotected sexual behaviors among men who have sex with men

INTRODUCTION The relationship between depressive symptomatology and risky sexual behaviors has been controversial in literature. AIM The current study aims to reexamine the relationship between depression and sexual behaviors among men who have sex with men (MSM) using different sets of analytical assumption. METHODS Six hundred twenty MSM were recruited in a lesbian, gay, bisexual, and transgender community center in Taiwan to participate in a cross-sectional survey. An additional variable of squared depressive symptomatology was used to detect nonlinearity between depressive symptomatology and logit-transformed unprotected anal intercourse (UAI) and unprotected oral sex (UOS). Multivariable logistic regression was applied to further estimate the relationship among the three variables. MAIN OUTCOME MEASURES Depressive symptomatology was measured by the Beck Depression Inventory (BDI), UAI, and UOS. RESULTS Depressive symptomatology had a nonlinear relationship with unprotected anal and oral sex. While linear BDI scores of MSM were not associated with unprotected sexual behaviors in the logistic model, their scores were significantly associated with unprotected sexual behaviors in the model that included both the linear (UAI, odds ratio [OR] = 1.087; P < 0.01; UOS, OR = 1.099, P < 0.01) and quadratic BDI scores (UAI, OR = 0.998, P < 0.01; UOS, OR = 0.997, P < 0.01). The relationship between BDI scores and the probability of unprotected sexual behaviors corresponded to an inverted U-shaped curve, as opposed to a straight line. CONCLUSIONS Our findings suggest that depressive symptomatology has a significant curvilinear relationship with unprotected sexual behaviors. MSM with moderate levels of depression may be at elevated risk of engaging in unprotected sexual behaviors in comparison to their peers who exhibit either significantly higher or lower depression scores.

Effect of antiretroviral therapy on the incidence of cervical neoplasia among HIV-infected women: a population-based cohort study in Taiwan

Objective:Cervical cancer has been recognized as one of the AIDS-defining cancers since 1993. Receipt of HAART has been shown to reduce the risk of opportunistic infection and AIDS-defining malignancies. However, findings concerning the effect of HAART on cervical neoplasia have been inconsistent. Design:A population-based cohort design was used, in which 1360 HIV-infected women were compared to the general population (HIV-negative women). The comparison population included 358 141 HIV-negative women randomly selected from among all insured persons in Taiwan in 2000. Data from HIV-infected and uninfected women were analyzed through 2008. Methods:The age and calendar year-standardized incidence ratio was calculated to estimate the relative risk of cervical neoplasia, and Cox proportional hazards models were used to assess the effect of HAART on the incidence of cervical neoplasia. Results:The incidence of cervical neoplasia was four times higher in the HIV-infected women than in the general population [standardized incidence ratio 4.0, 95% confidence interval (CI) 2.16–6.95]. The most increased risk was noted in HIV-infected women aged 40–59 years. Receipt of HAART was associated with a significantly reduced risk of cervical neoplasia (0.20, 0.05–0.77). The most evident protective effect was noted in adherent to HAART at least 85%, and those treated with HAART for more than 3 years (0.01, 0.00–0.47). Conclusions:HIV-infected women have a substantially increased risk of cervical neoplasia. Adherent to HAART and prolonged HAART for more than 3 years may contribute to a reduction risk of cervical neoplasia.

Seeking sex partners through the internet and mobile phone applications among men who have sex with men in Taiwan

ABSTRACT It has become popular for men who have sex with men (MSM) to use mobile-phone geosocial networking applications (mobile apps) to find sex partners. A cross-sectional online survey was conducted in Taiwan to compare the sexual and substance-use behaviors of MSM seeking sex partners through the internet and mobile apps. Of the 1060 participants, 65.8% used the internet via computer and 37.7% used a mobile app to find sexual partners, while 30.3% used recreational drugs or alcohol in the previous 6 months. MSM who exclusively used mobile apps to seek sex partners were significantly more likely than MSM seeking sex via computer to be older, to have used recreational drugs or alcohol, and to have sex with HIV-positive partners. Additionally, using mobile apps to seek sex partners was significantly associated with having sex with online partners through either mobile apps or computer-based internet use (adjusted odds ratio (AOR), 7.12 [3.87–13.11]), self-reporting as HIV-positive (AOR, 2.24 [1.12–4.12]), using recreational drugs (AOR, 1.67 [1.21–2.32]), having disclosed HIV status to sexual partners (AOR, 1.44 [1.03–2.02]), and having sex with HIV-positive partners (AOR, 1.81 [1.06–3.10]). In conclusion, the mobile apps may serve as a feasible platform for HIV-positive MSM to find other HIV-positive partners.

Effect of D to E mutation of the RGD motif in rhodostomin on its activity, structure, and dynamics: Importance of the interactions between the D residue and integrin

Rhodostomin (Rho) is a snake venom protein containing an RGD motif that specifically inhibits the integrin‐binding function. Rho produced in Pichia pastoris inhibits platelet aggregation with a KI of 78 nM as potent as native Rho. In contrast, its D51E mutant inhibits platelet aggregation with a KI of 49 μM. Structural analysis of Rho and its D51E mutant showed that they have the same tertiary fold with three two‐stranded antiparallel β‐sheets. There are no structural backbone differences between the RG[D/E] loop which extends outward from the protein core and the RG[D/E] sequence at its apex in a four‐residue RG[D/E]M type I turn. Two minor differences between Rho and its D51E mutant were only found from their backbone dynamics and 3D structures. The R2 value of E51 is 13% higher than that of the D51 residue. A difference in the charge separation of 1.76 Å was found between the sidechains of positive (R49) and negative residues (D51 or E51).The docking of Rho into integrin αvβ3 showed that the backbone amide and carbonyl groups of the D51 residue of Rho were formed hydrogen bonds with the integrin residues R216 and R214, respectively. In contrast, these hydrogen bonds were absent in the D51E mutant‐integrin complex. Our findings suggest that the interactions between both the sidechain and backbone of the D residue of RGD‐containing ligands and integrin are important for their binding. Proteins 2009.

Low Papanicolaou smear screening rate of women with HIV infection: a nationwide population-based study in Taiwan, 2000-2010.

BACKGROUND Women infected by human immunodeficiency virus (HIV) have a higher risk of contracting cervical cancer. Recent guidelines recommend that all HIV-positive women should receive two Pap smears in the first year after their HIV diagnosis. METHODS This was a population-based cohort study, and the National Health Insurance Research Database (NHIRD) in Taiwan was used to estimate the Pap smear screening rate for 1449 HIV-infected women aged 18 years and over from 2000 to 2010. A multiple logistic regression analysis was used to identify factors associated with HIV-infected women who had received Pap smears. RESULTS Of 1449 women, 618 (43%) women received at least one Pap smear. Only 14.7% of the HIV-infected women received Pap smears within one year after being diagnosed with HIV. A logistic regression analysis showed that the factors associated with receiving at least one Pap smear after HIV diagnosis were increasing age (AOR 1.04, 95% CI 1.03-1.05), high monthly income (AOR 1.83, 95% CI 1.51-2.23), any history of antiretroviral therapy (AOR 1.78, 95% CI 1.38-2.29), retention in HIV care (AOR 1.36, 95% CI 1.04-1.77), a history of sexually transmitted diseases (AOR 1.96, 95% CI 1.50-2.56), and any history of treatment for opportunistic infections (AOR 2.46, 95% CI 1.91-3.16). CONCLUSIONS A great need exists to develop strategies for promoting receipt of Pap smear screening services that specifically target severely disadvantaged women with HIV, particularly younger, lower income women and those in an asymptomatic phase.

The rising trend of sexually transmitted infections among HIV-infected persons: A population-based cohort study in taiwan, 2000 through 2010

Objective:Positive prevention interventions for patients living with the HIV include the early detection and treatment of sexually transmitted infections (STIs). This study aimed to determine the incidence of selected STIs, including syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis, in a population-based cohort of individuals living with HIV. Methods:Clinical data from 2000 to 2010 were obtained from the Taiwan National Health Insurance Research Database identified 15,123 patients with HIV infection. The incidence rates were standardized by age and sex using the direct method that was based on the 2000 World Health Organization world standard population. Results:The overall rate ratio of STI episodes significantly increased [rate ratio: 34.0, 95% confidence interval (CI): 24.3 to 47.6, P < 0.01]. After an HIV diagnosis, 15.9% of patients with HIV had at least 1 of these 5 STIs. An incidence rate of 503.0 STI episodes/10,000 person-years (PYs) (95% CI: 487.1 to 519.5) was detected during the 11-year follow-up period. The most common STIs after an HIV diagnosis were syphilis (381.9 episodes/10,000 PYs; 95% CI: 368.0 to 396.3), followed by genital warts (138.9 episodes/10,000 PYs; 95% CI: 130.6 to 147.6). The incidence of STIs varied significantly according to gender. In women, the annual incidence of STIs remained stable. However, the annual incidence of syphilis, genital warts, and chlamydial infection increased in young men. Conclusions:An increase in STIs among HIV-positive persons highlights the need to identify the causal factors of these co-infections. Routine STI screenings and early preventive interventions against STIs in HIV-infected persons are crucial.

The impact of nurse-led case management on the quality of HIV care

BACKGROUND Monitoring the quality of human immunodeficiency virus (HIV) care and evaluating the effectiveness of HIV case management programs (CMPs) as approaches to raising the rate of HIV care retention and to improving the efficacy of viral suppression after the initiation of highly active antiretroviral therapy (HAART) are important focuses of research worldwide. PURPOSE This study describes the trends and evaluates the influence of CMPs on retention in care and viral suppression among patients in Taiwan diagnosed with HIV from 2008 to 2010. METHODS This retrospective study enrolled 1,302 HIV-positive individuals who had visited at least one outpatient clinic between 2008 and 2012. Of these patients, 715 (54.9%) were enrolled in an HIV CMP. Trend analysis and logistic regression were applied to investigate longitudinal trends and the impact of CMPs on the quality of HIV care. RESULTS Retention in care improved substantially from 44.5% in 2008 to 57.3% in 2012. The percentage of viral suppression within 12 months of the initiation of HAART increased from 88.4% in 2008 to 93.5% in 2012. Of the patients who were in HIV CMPs, 73.6% were retained in care, which was significantly higher than the 31.7% among those who were not enrolled in CMPs (p<.001). Among the patients who received HAART for more than 180 days, those who achieved viral suppression within 12 months were significantly more likely to be retained in care (adjusted odds ratio=5.36, 95% CI=2.6-10.9, p<.001). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Nurse-led case management programs play a role in improving HIV-related health outcomes. HIV CMPs are beneficial to HIV-infected patients by improving retention in care and are indirectly associated with successful viral suppression.

A Prospective Study of Interactions Between a Case Management Program and Retention in Care on HIV Suppression in Taiwan, 2008–2012

Dear Editor Achieving optimal antiretroviral treatment outcomes is a fundamental treatment as prevention (TasP) strategy. A successful program for HIV treatment includes making the diagnosis of HIV infection, linking infected individuals to outpatient care, and retaining patients in care. Case management (CM) has been shown to facilitate entry and engagement in care among persons living with HIV. In the United States, HIV CM is a federally legislated program funded by the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 (now the Ryan White Treatment Modernization Act). Japan, Brazil, and Rwanda have also initiated a integrated case management program by the government. HIV-infected patients in Taiwan have been provided with free antiretroviral therapy and medical care at AIDS-designated hospitals since the early 1990s. An estimated 70% of individuals living with HIV infection in Taiwan have sought HIV care, and 40% of individuals who have sought HIV care received HAART after the diagnosis of HIV infection with CD4 cell counts < 350 cells/mm. In 2005, the Taiwan Center for Disease Control (Taiwan CDC) initiated an HIV case management (CM) program in AIDS-designated hospitals to provide integrative services and risk reduction counseling for HIV-infected individuals. The current study provides a unique opportunity to observe the impact of HIV case management on achieving the optimal therapeutic effect of HAART among HIV-infected persons. A longitudinal prospective cohort study was conducted at an AIDS-designated hospital, National Cheng Kung University Hospital (NCKUH), with over 15 years of experience caring for HIV-infected patients in southern Taiwan. A total of 549 patients who were newly diagnosed during 2008–2012 provided data for analysis. Of the 549 patients, 427 (77.8%) ever enrolled in the hospital-based HIV case management program. Retention in care was defined as having two or more HIV clinical visits separated by ‡ 90 days during a calendar year over the 5-year observation period. Achievement of viral suppression was defined as the first HIV RNA level of < 400 copies per milliliter, and time to viral suppression was defined as the number of days between the initial diagnosis of HIV and the first viral load (VL) of < 400 copies per milliliter. Patients who never had a VL > 1000 copies per milliliter after viral suppression (VL < 400 copies per milliliter) by the time of death or at the end of the analysis period were considered to have maintained suppression. Of the 549 patients, the mean age was 31.6 years (SD 9.7, range: 16–77 years), 95.3% were male, and 69.2% reported men having sex with men (MSM) as a primary risk factor for HIV transmission. Median initial CD4 count during the year rose from 55.2 to 185.9 cells/mm. Applying the pre-2013 HAART initiation threshold of CD4 < 350 cells per cubic millimeter, 52–60% would have been eligible to begin HAART based on the first CD4 after the initial diagnosis. Almost two-thirds (n = 335, 72.2%) of the patients were retained in care until the end of the 5-year study period. The adjusted multivariate logistic regression indicated that persons retained in HIV care were significantly more likely to be female [adjusted odds ratio (aOR) 0.25, 95% confidence interval (CI): 0.75–0.84], to have initiated HAART (aOR 4.91, 95% CI: 2.81–8.60), and to be enrolled in the case management program (aOR 2.15, 95% CI: 1.11–4.16) than persons not retained in care during years 2008–2012. Overall, 257 (61.8%) of the patients newly diagnosed with HIV during 2008–2012 ever achieved viral suppression by the end of 2012; 26.6% achieved suppression within 6 months of diagnosis, and 39.8% within 12 months. Overall, 57.6% of the 257 persons who ever achieved viral suppression maintained their suppression for 12 months. Cox proportional hazards models showed significant interaction effects between retention in care and enrollment in CMP on viral suppression (Table 1). The patients were divided into three groups: retained in care plus case management (n = 294, 53.6%), either retained in care or enrolled in case management only (n = 174, 31.4%), and irregular/lost to follow-up and also without case management (n = 81, 14.8%). The Kaplan-Meier survival analysis showed that patients who were retained in care and also enrolled in CMP had the best outcomes of achieving viral

Complex problems, care demands, and quality of life among people living with HIV in the antiretroviral era in Indonesia

&NA; People living with HIV (PLWH) suffer from physical and psychological distress that palliative care could alleviate. Our cross‐sectional study identified HIV‐related problems and demands for palliative care at different disease stages, and their interactions with quality of life (QOL) in 215 PLWH from a referral hospital and an AIDS nongovernmental organization in Indonesia. A brief survey of demographic information, the Bahasa version of Problems and Needs of Palliative Care, and the World Health Organization Quality of Live in HIV‐infected Persons instrument (WHOQOL‐HIV BREF; Cronbachs alpha = .89) were used for data collection. Mean age was 33.5 years (SD = 4.7); 66% were male. Fatigue (67%) was the most prevalent symptom, and the symptom sleeping problems (54.9%) was the priority for palliative care. Higher spiritual and financial demands were found in PLWH with stage IV HIV. Multivariable analysis indicated negative associations between QOL and psychosocial problems, and demands for social and financial support. Interventions focused on psychosocial issues would improve the QOL for PLWH.

Incidence of Neurological Disorders among HIV-Infected Individuals with Universal Health Care in Taiwan from 2000 to 2010

Objective: To determine the incidence of and factors associated with neurological disorders in a large Taiwanese cohort of HIV-infected persons with free access to highly active antiretroviral therapy (HAART). Design: A retrospective population-based cohort study was conducted using the National Health Insurance Research Database for the years 2000–2010. Methods: We identified 13,316 HIV-positive persons from 2000 through 2010. We used direct standardization to calculate age-adjusted and sex-adjusted incidence rates based on the 2000 World Health Organization world standard population. Factors associated with neurological disorders were analyzed using a Cox proportional hazards model. Results: The standardized incidence of neurological disorders among HIV-infected persons increased from 22.16 per 1000 person-years in 2000 to 25.23 per 1000 person-years in 2010. Cognitive disorders increased significantly from 0.36 per 1000 person-years in 2001 to 7.44 per 1000 person-years in 2010 (trend P < 0.001). The rate of neurological disorders increased with age ≥55 years [adjusted hazard ratios (AHRs) 2.54, 95% confidence interval (CI): 1.89 to 3.40], hypertension (AHR 1.41, 95% CI: 1.12 to 1.76), substance abuse (AHR 1.65, 95% CI: 1.36 to 2.02), opportunistic infection (AHR 1.76, 95% CI: 1.47 to 2.11), syphilis (AHR 1.27, 95% CI: 1.10 to 1.47), and emergency department visits >5 (AHR 2.41, 95% CI: 1.96 to 2.97). The incidence of neurological disorders was negatively associated with adherence to HAART (adherence ≥85% AHR: 0.79, 95% CI: 0.64 to 0.97). Conclusions: The rising incidence of cognitive disorders among HIV-positive persons highlights the need to provide routine neurological evaluations at clinical visits. Receiving HAART with adherence ≥85% contributes to a reduced risk of neurological disorders.