Wen-Chien Ko

Background: Invasive meningococcal disease (IMD) is uncommon but associated with substantial mortality and long-term sequelae. Population-based evidence from Asia-Pacific settings remains scarce, and long-term evidence on post-IMD sequelae, healthcare utilization, and medical costs is limited. This study evaluated the long-term burden of IMD across all age groups in Taiwan.Methods: We conducted a nationwide population-based study by linking confirmed IMD cases from Taiwan Centers for Disease Control surveillance data during 2002–2020 to the National Health Insurance Research Database, with follow-up through 2021. IMD-related sequelae, healthcare utilization, and medical costs were examined overall and stratified by age group and sequelae status. Regression analyses were used to identify factors associated with sequelae, medical costs, and all-cause mortality. Findings: Among 217 linked IMD cases, the mean age was 29.7 years, and 57% were male. Serogroup B was the predominant subtype among patients with available information. During follow-up, all-cause mortality was 33%, increasing from 14% in children aged≤12 years to 79% in adults aged≥65 years. Overall, 24% of patients experienced at least one complication or sequela, most commonly neurological impairment. Mean annual medical costs increased 2.6-fold in the first year after diagnosis. Older age and higher comorbidity burden were associated with both mortality and higher medical costs. Interpretation: IMD remains associated with substantial long-term burden in Taiwan, particularly among older adults and survivors with sequelae. These nationwide linked data provide region-specific evidence for future surveillance, economic evaluation, and life-course prevention policy discussions in Taiwan and the broader Asia-Pacific region.

Introduction: This study aimed to evaluate longitudinal changes in CVD risk and identify the contributing factors among HIV-positive individuals. Methods: A 12-month prospective study was conducted at an AIDS treatment center in southern Taiwan. A total of 411 adults living with HIV, aged 18 years or older, with no history of CVD treatment, were enrolled. CVD risk was assessed at baseline and 6 and 12 months using the D:A:D risk prediction model. Mixed-effects models were used to examine associated factors. Results: participants ranged in age from 19 to 77 years, with 95.9% being male. At baseline, 47% of the patients were low-risk, 37.7% were moderate-risk, 10.9% were high-risk, and 4.4% were very high-risk. After 12 months, 19% of participants showed a reduction in CVD risk. Increased risk was significantly associated with hepatitis C co-infection, use of lopinavir- or abacavir-based ART, and a longer duration of lopinavir exposure. Conversely, reductions in CVD risk were linked to higher educational attainment, use of antihypertensive or lipid-lowering therapy, and adherence to a Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-based antiretroviral therapy regimen. Conclusions: CVD risk in PLHIV is dynamic and modifiable. The use of NNRTI-based regimens and lipid-lowering therapies contributed to a significant risk reduction. Comprehensive integrated management strategies addressing both HIV infection and cardiovascular health are essential. Further research is needed on the cardiovascular effects of integrase inhibitors (INSTIs), particularly their long-term effects on lipid profiles and endothelial function.

Asymptomatic Clostridioides difficile colonization (CdC) serves as a reservoir for pathogen transmission and may precede clinical infection. While risk factors for CdC have been well described in hospitalized populations, community-based data—particularly regarding lifestyle-associated factors and gut microbiota alterations—remain limited in Taiwan. This study aimed to determine the prevalence and risk factors of community-acquired CdC and to explore associated gut microbiota differences. We conducted a cross-sectional study analyzing 250 residual stool samples from adults aged ≥40 years who participated in community health screenings in Tainan City between 2006 and 2009. CdC was detected by polymerase chain reaction targeting the triosephosphate isomerase (tpi) gene. Demographic characteristics, lifestyle factors, and laboratory parameters were collected and analyzed. Exploratory 16S rRNA gene sequencing was performed on selected samples to compare gut microbiota composition between CdC and non-CdC groups. The prevalence of CdC was 11.6% (29/250). Cigarette smoking was identified as the sole independent factor associated with CdC (adjusted OR 2.35, 95% CI 1.05–5.28; P = 0.038). Exploratory microbiota analysis revealed differences in community composition between CdC and non-CdC samples, including increased relative abundance of Proteobacteria in CdC. Cigarette smoking was associated with an increased likelihood of community-acquired CdC in southern Taiwan. Distinct gut microbiota profiles were observed in individuals with CdC, supporting a potential link between smoking-related microbiota alterations and susceptibility to asymptomatic colonization. These findings underscore the relevance of modifiable lifestyle factors in the epidemiology of community CdC and warrant further investigation.