No abstract

We describe the clinical course and virological characteristics of the first H7N9 influenza case in a Taiwanese patient; this patient had detectable viruses in the airway for 2 weeks, during which time an oseltamivir resistance-associated R292K mutation rapidly emerged. Anti-H7N9 antibody was detected 21 days after onset of symptoms, when H7N9 viral load declined significantly.

Background: Increasing trends of HCV infection have been reported among HIV-positive men who have sex with men (MSM) in Europe, Australia and North America. The trends of recently acquired HCV infection among HIV-positive MSM are less clear in AsiaÀpacific region. Methods: All HIV-positive patients seeking care at a university hospital in Taiwan tested for anti-HCV IgG at least once annually to estimate the incidence of HCV seroconversion during 2011À2018. HCV genotyping and sequencing were performed and multivariate logistic regression analysis was conducted to identify the factors associated with HCV seroconversion among MSM. Findings: During the study period, 3495 HCV-seronegative patients (86¢4% MSM) were included and 294 (8¢4%) with recent HCV infection were identified, in whom 281 (95¢6%) were MSM, during a total of 16,361¢86 person-years of follow-up (PYFU), giving an overall incidence rate of 17¢97 per 1000 PYFU, which increased from 14¢28 per 1000 PYFU in 2011 to 25¢38 per 1000 PYFU in 2018 (p<0¢001). HCV seroconversion among MSM was associated with aspartate aminotransferase 37 U/L (adjusted odds ratio [AOR] 7¢50, 95% CI 4¢17À13¢50), alanine aminotransferase 41 U/L (AOR 7¢47, 95% CI 4¢11À13¢58), and syphilis acquisition (AOR 2¢88, 95% CI 1¢67À4¢97). Among the 277 (94¢2%) with HCV viremia, genotype 2a (n = 116) was the leading genotype, followed by 1b (n = 85), 6a (n = 34), and 1a (n = 21). Genotypes 3a and 6a increased from 0% and 5¢2%, respectively, in 2011À2014 to 4¢1% and 17¢1% in 2015À2018. Phylogenetic analysis revealed increased clusters in genotypes 2a, 3a and 6a from 2011-2014 to 2015À2018. Interpretation: An expanding HCV epidemic among HIV-positive MSM is occurring in Taiwan. Improving access to HCV testing and early linkage to treatment are needed to curb the expanding HCV epidemic.

Our three-stage pooled plasma HCV RNA testing successfully identified HCV viremia in high-risk PLWH with a testing cost reduction of 84.5%. Simulation analysis offered detailed information regarding the selection of pool and mini-pool sizes in settings of different HCV epidemiology and the performance of HCV RNA testing to optimize the cost reduction.