Korean Patients Presenting with Advanced Human Immunodeficiency Virus Disease: Epidemiological Features by Age Group

We explored factors influencing presentation with advanced human immunodeficiency virus (HIV) disease by age group. Data were derived from a city-wide cross-sectional survey of 759 HIV-infected adults living in Seoul, Korea. The significance of each observed factor was assessed via multivariate logistic regression. 

Of subjects aged 20-34 years, lower educational level had a positive influence on presentation with advanced HIV disease; those recently diagnosed with HIV were more likely to be presented with advanced HIV disease. Of the subjects aged 35-49 years, those w ith advanced HIV disease were more likely to have been diagnosed during health check-ups or via clinical manifestations. Of the subjects aged ≥ 50 years, presentation with advanced HIV disease was significantly more common in older subjects and less common among individuals diagnosed with HIV in 2000-2006. 

In conclusion, a lower educational level in younger subjects and more advanced age in older subjects positively influence the presentation of advanced HIV disease.

Full article at:   http://goo.gl/wa5zKL

By:  Cho Ryok Kang,1,7 Ji Hwan Bang,1,2 Sung-Il Cho,1,3 Kui Nam Kim,4 Hee-jin Lee,4 Bo Yeong Ryu,1,7 Soo Kyung Cho,1,7 Young Hwa Lee,1,3 Myoung-don Oh,1,5 and Jong-Koo Lee1,6

¹Seoul Center for Infectious Disease Control, Seoul, Korea.

²Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

³Department of Epidemiology, Seoul National University Graduate School of Public Health, Seoul, Korea.

⁴Division of Life & Health, Seoul Metropolitan Government, Seoul, Korea.

⁵Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

⁶Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea.

⁷Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author.

Address for Correspondence: Ji Hwan Bang, MD. Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center 20 Boramaero 5-gil, Dongjak-gu, Seoul 07061, Korea. Tel: +82.2-870-3209, Fax: +82.2-831-2826, Email:moc.liamg@hcribdnuor

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Risk Factors for Hepatitis C Virus (HCV) Infection in Areas with a High Prevalence of HCV in the Republic of Korea in 2013

BACKGROUND/AIMS:

The prevalence of hepatitis C virus (HCV) infection in Busan, Gyeongnam, and Jeonnam Provinces in Korea is more than twice the national average. This study aimed to examine whether demographic and lifestyle characteristics are associated with HCV infection in these areas.

METHODS:

A case control study was performed at three study hospitals. HCV cases were matched with two controls for sex and age. Patient controls were selected from non-HCV patients at the same hospital. Healthy controls were subjects participating in medical checkups. Conditional logistic regression models were used.

RESULTS:

A total of 234 matched-case and patient- and healthy-control pairs were analyzed. The significant risk factors for both controls were sharing razors (adjusted odds ratio [aOR], 2.39 and 3.29, respectively) and having more than four lifetime sexual partners (aOR, 2.15 and 6.89, respectively). Contact dockworkers (aOR, 1.91) and tattoos (aOR, 2.20) were significant risk factors for the patient controls. Transfusion (aOR, 5.38), a bloody operation (aOR, 5.02), acupuncture (aOR, 2.08), and piercing (aOR, 5.95) were significant risk factors for the healthy controls. Needle stick injuries and intravenous drug abuse were significant in the univariate analysis.

CONCLUSIONS:

More education concerning the dangers of sharing razors, tattoos and piercings is required to prevent HCV infection. More attention should be paid to needle stick injuries in hospitals and the community.

Full article at:  http://goo.gl/0O7JnR

By:  Sohn HS1, Kim JR2, Ryu SY3, Lee YJ4, Lee MJ5, Min HJ6, Lee J7, Choi HY8, Song YJ9, Ki M8.

• 1Department of Preventive Medicine, Inje University College of Medicine, Busan, Korea.
• 2Department of Preventive Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
• 3Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea.
• 4Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea.
• 5Department of Health and Medical Administration, Suncheon Jeil College, Suncheon, Korea.
• 6Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
• 7Department of Internal Medicine, Chosun University Medical School, Gwangju, Korea.
• 8Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
• 9Department of Preventive Medicine, College of Medicine, Eulji University, Daejeon, Korea. 
• Gut Liver. 2016 Jan 23;10(1):126-32. doi: 10.5009/gnl14403.

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Vitamin C Deficiency of Korean Homeless Patients Visiting to Emergency Department with Acute Alcohol Intoxication

Vitamins are essential micronutrients for maintenance of tissue functions. Vitamin deficiency is one of the most serious and common health problems among both chronic alcoholics and the homeless. However, the vitamin-level statuses of such people have been little studied. We evaluated the actual vitamin statuses of alcoholic homeless patients who visited an emergency department (ED). 

In this study the blood levels of vitamins B1, B12, B6, and C of 217 alcoholic homeless patients were evaluated retrospectively in a single urban teaching hospital ED. Vitamin C deficiency was observed in 84.3% of the patients. The vitamin B1, B12, and B6 deficiency rates, meanwhile, were 2.3%, 2.3%, and 23.5%, respectively. Comparing the admitted patients with those who were discharged, only the vitamin C level was lower. (P=0.003) In fact, the patients' vitamin C levels were markedly diminished, vitamin C replacement therapy for homeless patients should be considered in EDs.

Below:  Scatter plots of blood levels of vitamins. The lower lines represent lower-normal levels, and the upper lines, upper-normal levels.

Full article at:   http://goo.gl/6a3CF5

By:   Hui Jai Lee, Jonghwan Shin, Kijeong Hong, and Jin Hee Jung

Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

Corresponding author.

Address for Correspondence: Jonghwan Shin, MD. Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20 Boramae-5-gil, Dongjak-gu, Seoul 07061, Korea. Tel: +82.2-870-2662, Fax: +82.2-831-2826, Email:moc.revan@renihsyks

J Korean Med Sci. 2015 Dec; 30(12): 1874–1880.

Published online 2015 Nov 30. doi:  10.3346/jkms.2015.30.12.1874

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Sexually Transmitted Infections & First Sexual Intercourse Age in Adolescents: The Nationwide Retrospective Cross-Sectional Study

Abstract

INTRODUCTION:

Sexually transmitted infections (STIs) are major causes of medical and psychological problems globally, while adolescents in South Korea have recently shown rapid changes in sexual behaviors.

AIMS:

We aimed to examine the association between the age of first sexual intercourse and the experience of STIs among adolescents. Additionally, in which specific time period would more likely to get infected from sexual intercourse.

METHODS:

We used data from the 2007-2013 Korea Youth Risk Behavior Web-based Survey. Only adolescents with sexual intercourse experience (N = 22,381) were included, and multiple logistic regression analysis was performed.

MAIN OUTCOME MEASURES:

One dichotomized measure and one continuous measure were assessed: (i) STIs experience (defined as having had STIs); and (ii) association between STIs experience and absolute age gap (defined as temporal differences between secondary sexual character emergence age and first sexual intercourse age).

RESULTS:

Approximately 7.4% of boys and 7.5% of girls reported had STI. For both boys and girls, the chance of experiencing STIs increased as the age of first sexual intercourse decreased (boys: before elementary school [age 7 or under]: odds ratio [OR] = 10.81, first grade [age 7 or 8]: OR = 4.44, second grade [age 8 or 9]: OR = 8.90, fourth grade [age 10 or 11]: OR = 7.20, ninth grade [age 15 or 16]: OR = 2.31; girls: before elementary school: OR = 18.09, first grade: OR = 7.26, second grade: OR = 7.12, fourth grade: OR = 8.93, ninth grade: OR = 2.74). The association between the absolute age gap and STI experience was examined additionally (boys: OR = 0.93, girls: OR = 0.87).

CONCLUSIONS:

This study shows that earlier initiation of sexual intercourse increases the odds of experiencing STIs. Also as the age gap gets shorter, the odds of experiencing STIs increase. Our study suggests that it is important to consider the time period of first sexual intercourse and to reinforce a monitoring system along with the development of other preventive strategies. 

Full article at:   http://goo.gl/5Ky2q7

By:   Lee SY1,2, Lee HJ2,3, Kim TK2,3, Lee SG2,4, Park EC2,5.

• 1Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea.
• 2Institute of Health Services Research, Yonsei University, Seoul, South Korea.
• 3Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea.
• 4Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea.
• 5Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea. 

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Achievements in and Challenges of Tuberculosis Control in South Korea

After the Korean War (1950–1953), nearly 6.5% of South Korea’s population had active tuberculosis (TB). In response, South Korea implemented the National Tuberculosis Program in 1962. From 1965 to 1995, the prevalence of bacteriologically confirmed pulmonary TB in South Korea decreased from 940 to 219 cases per 100,000 population. Astounding economic growth might have contributed to this result; however, TB incidence in South Korea remains the highest among high-income countries. The rate of decrease in TB incidence seems to have slowed over the past 15 years. A demographic shift toward an older population, many of whom have latent TB and various concurrent conditions, is challenging TB control efforts in South Korea. The increasing number of immigrants also plays a part in the prolonged battle against TB. A historical review of TB in South Korea provides an opportunity to understand national TB control efforts that are applicable to other parts of the world.

Below:  Number of tuberculosis (TB) cases per 100,000 population in South Korea, 1926–2013. Major periods are demarcated by dotted lines. Historical tuberculosis milestones for each period are briefly described. Notable tuberculosis control efforts are summarized in the boxes. GDP, gross domestic product; PPM, public–private mix. Sources: (1,4–6).

Below:  Relationship between per capita gross domestic product (GDP) and incidence of tuberculosis (TB), 2013. Each dot represents 1 country; South Korea is indicated. The third root of the population was used to determine the size of the circles, and the figure is drawn on a logarithmic scale. The line indicates the regression on the logarithm. The figure was adapted from (19) with permission from The European Respiratory Society. Updated data was derived from (1).

Full article at: http://goo.gl/ixDJoR

By: Ji Han Kim and Jae-Joon Yim 

Author affiliations: Seoul National University College of Medicine, Seoul, South Korea

  

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Associated with Differences in Sexual Risk-Taking Behaviors among Migrants in South Korea

We investigated influential factors on differences in sexual risk-taking among homosexual migrants. The data used in this paper are based on the survey and medical examination for migrants' sexual behaviors that was carried out by the Korea Federation for HIV/AIDS Prevention in 2011-2013 on participants living in South Korea. 

Among 1141 migrants, 

• homosexuals were 0.54 times less likely to use condom than heterosexuals. 
• Homosexuals were 2.93 times more likely to be infected with sexually transmitted diseases (STDs) than heterosexuals. 

Among 250 homosexual migrants, 

• those who preferred risky sexual intercourse were 0.19 times less likely to use a condom than heterosexual migrants. 
• Those who have a fixed sexual partner were 0.35 times less likely to be infected with HIV than their counterparts. 

Administrative programs for STDs prevention of migrants should be focused on their sexual risk-taking, which were limited to casual partnership, unprotected sex, and previous contraction of sexual diseases.

Purchase full article at: http://goo.gl/rbjvfF

By: Jung M1,2, Kwon D3, Oh JY3.

• 1Department of Health Science, College of Natural Sciences, Dongduk Women's University, 23-1 Wolgok-dong, Seongbuk-gu, Seoul, South Korea, 136-714. mj748@dongduk.ac.kr.
• 2Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA. mj748@dongduk.ac.kr.
• 3Korea Federation for HIV/AIDS Prevention, Seoul, South Korea

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Identifying Barriers to Human Immunodeficiency Virus Testing for Men Who Have Sex with Men in South Korea

The principal objective of this study was to identify the barriers to testing for men who have sex with men (MSM) in Korea, something that might prove useful in future studies of this nature.

This study was conducted at gay bars nationwide in Korea. After considering several offline locations (gay bars) where MSM candidates are commonly located, random recruitment was performed using time–location sampling. A total of 944 individuals participated in this survey. A total sample of 921 cases (23 cases were excluded) was used for analysis. A self-administered questionnaire measuring the individuals' demographics, human immunodeficiency virus (HIV)/AIDS knowledge, stigma, phobia, optimism bias, self-efficacy for condom use, and sexual practices was used.

About 61.8% (N = 569) of respondents reported having been tested at least once in their lifetime, and 38.9% (N = 358) acknowledged being tested within the past 12 months. After adjusting for age, education, and number of partners in a logistic regression analysis, awareness of testing place [odds ratio (OR) = 4.04], exposure to HIV prevention campaign (1.54), fear (OR = 1.13), and discrimination toward people with HIV/AIDS (OR = 0.94) were the main factors associated with HIV testing.

To accomplish widespread HIV testing for Korean MSM, the accessibility of testing centers and advertisement of voluntary counseling and testing to MSM are needed.

Table 2

HIV testing related behavior.

Characteristics		N	%
Number of partners (past 6 mo)	0	157	17.0
	1	303	32.9
	2–5	325	35.3
	6 and more	136	14.7
Condom usea (N = 685) (at last sexual encounter)	Yes	401	58.5
	No	284	41.5
Reported STIs	Yes	103	11.2
	No	818	88.8
Reported HIV	Yes	11	1.2
	No	838	91
	Not Sure	72	7.8
Total		921	100.0

HIV = human immunodeficiency virus; STI = sexually transmitted infection.

aPersons having had one and more partners in the past 6 months.

Table 4

Factors affecting HIV testing behavior.

		Model 1		Model 2		Model 3
		β	OR	β	OR	β	OR
Age (y)	19–29 (ref.)
	20–29	0.225	1.25	0.119	1.13	0.107	1.11
	30–39	0.074	1.08	−0.014	0.99	−0.128	0.88
	40–49	0.230	1.26	0.357	1.43	0.407	1.50
Education	High school and less (ref.)	—	—	—	—	—	—
	2 y of college	0.290	1.34	0.249	1.28	0.258	1.29
	4 y college and more	0.285	1.33	0.100	1.11	0.063	1.07
Number of partners	2 and less (ref.)	—	—	—	—	—	—
	3–5	–.133	0.88	−0.177	0.84	−0.216	0.81
	6 and more	0.490	1.63 *	0.319	1.38	0.221	1.25
Condom use	No (ref.)	—	—	—	—	—	—
	Yes	0.139	1.15	0.017	1.02	−0.016	0.98
HIV knowledge				0.169	1.18 *	0.132	1.14
Discrimination				−0.074	0.93 ***	−0.065	0.94 ***
Fear				0.120	1.13 **	0.122	1.13 **
Condom self-efficacy				0.064	1.07	0.053	1.06
Awareness of testing place						1.397	4.04 ***
Exposure to HIV prevention campaigning						0.433	1.54 *

* p < 0.05; ** p < 0.01; *** p < 0.001.

HIV = human immunodeficiency virus; OR = odds ratio; ref. = reference group.

Full article at: http://ht.ly/SZPkC 

By: Aeree Sohn,a,∗ Byonghee Cho,b and Harvey A. Kennedyc

^bGraduate School of Public Health, Seoul National University, Seoul, Korea

^c

aDepartment of Health Management, Sahmyook University, Seoul, Korea

bGraduate School of Public Health, Seoul National University, Seoul, Korea

cGraduate School of Health and Social Welfare, Sahmyook University, Seoul, Korea

aDepartment of Health Management, Sahmyook University, Seoul, Korea

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Changing Patterns of HIV Epidemic in 30 Years in East Asia

Via http://ht.ly/v976v

Abstract

The HIV epidemic in East Asia started relatively late compared to the rest of the world. All countries or areas, except for North Korea, had reported HIV and AIDS cases, with China being the major contributor to the epidemic. Though initially driven by injecting drug use in China, East Asia did not experience an explosive spread. Strong commitment in China and early harm reduction programs in Taiwan managed to reduce transmission substantially among injecting drug users. In contrast to China and Taiwan, injection drug use has accounted just a little, if not at all, for the spread of HIV in other East Asian counties. However, following a global trend, sexual contact has become a major route of infection across the region. While much progress has been achieved in this region, with the epidemic among other key populations relatively stable, the emerging epidemic through sex between men is a growing concern. Recent estimates suggest that HIV prevalence among men who have sex with men (MSM) has reached 6.3 % in China, 7.5 % in Mongolia, and ranges between 8.1 %-10.7 % in Taiwan and between 2.7 %- 6.5 % in South Korea. In Japan, 74 % of male HIV cases were among MSM in 2012, while Hong Kong has witnessed a sharp increase of HIV cases among MSM since 2004. There is urgent need to address issues of discrimination and stigma toward homosexuality, and to strengthen the strategies to reach and care for this population.