Narcolepsy and 2009 H1N1 pandemic vaccination in Taiwan.

BACKGROUND: Several European countries have observed an association between narcolepsy and H1N1 vaccines containing AS03® adjuvant in children/adolescents. In Taiwan, a nationwide campaign starting November 2009 administered H1N1 vaccines without adjuvant or with MF59® adjuvant to 67% of children and 12% of adults. METHODS: For those registered in the 2000-2012 National Health Insurance (NHI) databases, we compared age-stratified (0-4, 5-18, 19-59, and ≥60 years) incidence of first referral for a diagnostic MSLT for the pre-pandemic, pandemic/pre-vaccination, and vaccination/post-pandemic period. We also compared the odds of H1N1 vaccination in each chart-ascertained narcolepsy patient, whoever had an onset of excessive daytime sleepiness between April 2009 and December 2012, with 10 population-based controls from the NHI databases on year of birth, sex, and index date, using conditional logistic regressions. RESULTS: Incidence of MSLT referral for narcolepsy was highest and significantly increased in the pandemic/pre-vaccination period in the age group 5-18 (IRR 3.40, 95% confidence intervals (CI) 2.12-5.45) and 19-59 (IRR 2.90, 95% CI 1.62-5.02) years. Among 137 confirmed narcolepsy cases (86 adults and 51 children), the odds ratios (ORs) were 1.67 (95% CI 0.81-3.45) (adults) and 1.22 (95% CI 0.62-2.39) (children) for H1N1 vaccination without adjuvant, and 1.39 (95% CI 0.17-11.48) (adults) and 3.66 (95% CI 0.37-36.02) (children) with MF59® adjuvant. CONCLUSION: No substantial association between the use of H1N1 vaccines and narcolepsy was identified in Taiwan. Instead, the H1N1 infection itself could have played a role in triggering narcolepsy in children and young adults.

Analysis of veterinary drug residue monitoring results for commercial livestock products in Taiwan between 2011 and 2015.

Antibiotics have been widely used in the treatment of livestock diseases. However, the emergence of issues related to drug resistance prompted governments to enact a series of laws regulating the use of antibiotics in livestock. Following control of the problem of drug resistant bacteria, public attention has shifted to the recurring incidence of human health and safety issues caused by residual veterinary drugs in livestock products. To guarantee the safety and hygiene of meat, milk, and eggs from food-producing animals, governments and relevant agencies established laws and regulations for the use of veterinary drugs. It is, therefore, necessary to monitor the content of residual drugs in livestock products at regular intervals to assess whether the regulations have resulted in the effective management of food product safety, and to prevent and manage sudden problems related to this issue. A 2011-2015 livestock product post-marketing monitoring program launched by the Taiwan Food and Drug Administration (TFDA) inspected 1487 livestock products. Over the past 5 years, there were 34 samples identified that did not conform to the regulations; these samples included residue drugs such as ß-agonists, chloramphenicols, ß-lactam antibiotics, sulfa drugs, enrofloxacin, and lincomycin. Inspections of commercial livestock products with the consistent cooperation of agricultural authorities did not detect the drugs that were banned by the government, whereas the detection of other drugs decreased annually with an increase in the post-market monitoring sample size. In the future, the TFDA will continue to monitor the status of residual veterinary drugs in commercial livestock products, adjust the sampling of food products annually according to monitoring results, and closely cooperate with agricultural authorities on source management.

AuDis: an automatic CRF-enhanced disease normalization in biomedical text.

Diseases play central roles in many areas of biomedical research and healthcare. Consequently, aggregating the disease knowledge and treatment research reports becomes an extremely critical issue, especially in rapid-growth knowledge bases (e.g. PubMed). We therefore developed a system, AuDis, for disease mention recognition and normalization in biomedical texts. Our system utilizes an order two conditional random fields model. To optimize the results, we customize several post-processing steps, including abbreviation resolution, consistency improvement and stopwords filtering. As the official evaluation on the CDR task in BioCreative V, AuDis obtained the best performance (86.46% of F-score) among 40 runs (16 unique teams) on disease normalization of the DNER sub task. These results suggest that AuDis is a high-performance recognition system for disease recognition and normalization from biomedical literature.Database URL: http://ikmlab.csie.ncku.edu.tw/CDR2015/AuDis.html.

Mediating effects of social support on depression and quality of life among patients with HIV infection in Taiwan.

Few empirical studies have evaluated the mediating effects of quality of life (QoL) among people living with HIV/AIDS (PLWHA). The purposes of this study were to identify the predictors of QoL and to test the mediating effects of social support on depression and QoL among patients enrolled in an HIV case-management program in Taiwan. A cross-sectional, descriptive correlation design collected data from 108 HIV-infected individuals. Individuals were assessed using the Beck Depression Inventory II, the short version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF), and the Multidimensional Scale of Perceived Social Support between September 2007 and April 2010. After adjusting for sociodemographic characteristics (including age, gender, and mode of transmission) and clinical information (including CD4 count and time since diagnosis with HIV), the study findings showed that QoL was significantly and positively correlated with both social support and the initiation of highly active antiretroviral therapy (HAART), and was negatively correlated with depression and time since diagnosis with HIV. The strongest predictors for QoL were depression followed by the initiation of HAART and social support, with an R(2) of 0.40. Social support partially mediated the relationship between depression and QoL. Health professionals should enhance HIV-infected individuals' social support to alleviate the level of depression and further increase the QoL among PLWHA.

Pneumocystis jiroveci pneumonia in immunocompromised patients: delayed diagnosis and poor outcomes in non-HIV-infected individuals.

BACKGROUND: Pneumocystis jiroveci pneumonia (PJP) is a life-threatening disease in immunocompromised patients. Improved knowledge about the varied characteristics and management in different populations may guide treatment. METHODS: We evaluated the clinical characteristics, management, and outcomes of patients with PJP diagnosed by nested polymerase chain reaction at a medical center in southern Taiwan from 2008 to 2011. The risk factors of mortality among non-human immunodeficiency virus (HIV)-infected patients were analyzed. RESULTS: During the study period, there were 43 cases of PJP, and the common underlying diseases were HIV infection (23 patients, median CD4 count: 19/µl) and malignancy. The HIV-infected patients had a younger age (36.9 ± 13.7 vs. 50.2 ± 16.2 years, p = 0.006), a lower body mass index (19.9 ± 2.3 vs. 22.0 ± 3.7 kg/m(2), p = 0.035), a longer duration of symptoms before admission (24 ± 29 vs. 7 ± 15 days, p = 0.035), and a lower pneumonia severity index (56 ± 25 vs. 99 ± 35, p < 0.001) than non-HIV-infected patients. A delay between admission and starting antimicrobial therapy for PJP (10 ± 10 days vs. 1 ± 3 days, p = 0.004) and a high crude mortality (12/20, 60% vs. 2/23, 9%, p = 0.001) were noted in non-HIV-infected patients. In the univariate analysis, the risk factors for mortality were a low lymphocyte count (p < 0.05) and shock during hospitalization (p = 0.004). CONCLUSION: A delay in the initiation of antimicrobial therapy for PJP and severe pneumonia were more common in the non-HIV-infected patients and were most likely related to the poor prognosis. The utilization of sensitive diagnostic tools to facilitate early diagnosis and treatment may improve the clinical outcomes of non-HIV-infected patients with PJP.

Acrophialophora fusispora brain abscess in a patient with acquired immunodeficiency syndrome: a case report and review of the literature.

We reported a fatal case of brain abscess caused by Acrophialophora fusispora in a patient with acquired immunodeficiency syndrome. Identification of the fungus was based on microscopic morphology and sequence analyses of the internal transcribed spacer 1 (ITS1) and 2 (ITS2) of ribosomal RNA gene from the isolate recovered from brain abscess. Four published cases were reviewed as well.

Metastatic complications of pericarditis and cardiac tamponade as a result of Staphylococcus aureus bacteremia developing during antimicrobial therapy.

Acute bacterial pericarditis is a rare but devastating complication of Staphylococcus aureus bacteremia (SAB). We herein describe the case of a previously healthy 81-year-old woman with SAB complicated by pericarditis that evolved into cardiac tamponade despite the administration of optimal antimicrobial therapy for 11 days. Three adhesion factor genes, fnbA, clfA and clfB, were identified in the causative isolate.

HIV risk profiles differed by gender and experience of men who had sex with men among attendees of anonymous voluntary counseling and testing in Taiwan.

Free voluntary counseling and testing (VCT) has been available in Taiwan as a part of HIV surveillance and prevention program since 1999, but related data were seldom reported. We aimed to examine characteristics of individuals who attended anonymous client-initiated VCT service and factors associated with HIV infection. The study population consisted of clients at two large VCT sites located in northern and southern Taiwan in 2004- 2008. Information on socio-demographic factors and potential risk behaviors was obtained by a questionnaire. Of 5671 clients, 65.1% were younger than 30 years; 42.0%, 41.2%, and 16.8% were men who ever had sex with men (MSM), non-MSM males, and women with HIV seropositivity of 8.0%, 1.2%, and 1.5%, respectively. The proportion of clients who confirmed having a prior HIV test was 66.5% in MSM, followed by 43% in non-MSM, and 30.2% in women. Correlates of HIV seropositivity differed between genders: ever engaging in commercial sex, being married or less educated were associated with increased risks among women but not for men. Different independent predictors were revealed among three groups of clients by multivariable analyses: illicit drug use, anal sex behavior, sexual partner(s) with HIV, and one-night stand in MSM; injection drug use and history of sexually transmitted infections in non-MSM; and injection drug use, sexual partner(s) with HIV and trading sex in women. Of all three groups, illicit drug or injection drug use was associated with the highest risks among all independent predictors. In this population of VCT clients in Taiwan, risk profiles of HIV infection differed according to gender and MSM experience, and different prevention strategies are needed to target different risk groups. In women, risk factors related to low social demographic and relationship power deserves attention in planning future prevention efforts.

High prevalence of anal human papillomavirus infection and associated risky behaviors in men infected with human immunodeficiency virus in Taiwan.

A cross-sectional study was conducted to investigate the prevalence, types, and risk factors associated with anal HPV infection among HIV-infected men in outpatient clinics at an AIDS designated hospital in Taiwan. Anal swabs were collect and PCR (polymerase chain reaction) was used to analyze the types of anal HPV infection. HPV DNA was detected in 74.2% of the 198 participants, including high-risk types (40.4%), low-risk types (18.2%) and multiple-types (6%). The most common types were HPV 16 (13.1%), 6 (10.4%), 11 (7.1%) and 18 (6.1%). The significant risk factor for being infected with any type or a high-risk type of HPV was having sexual partners (>3) in the preceding 6 months. Low-risk type of anal HPV infection was associated with a history of anal lesions. Our findings support the need for regular follow-up of all HIV/HPV coinfected patients and their partners to allow early detection of anal intraepithelial neoplasia.

Murine typhus in southern Taiwan during 1992-2009.

Clinical information regarding murine typhus in Taiwan is limited. In this study, 81 cases of serologically documented murine typhus during 1992-2009 at four referral hospitals in southern Taiwan were analyzed. There was a significant correlation between average environmental temperature and case numbers of murine typhus (r = 0.747, P = 0.005). Acute hepatitis was found in 67% of cases, and hyperbilirubinemia (serum total bilirubin ≥ 23.9 µmol/L) was found in 38%. The intervals between the initiation of appropriate therapy to defervescence were longer in patients with hyperbilirubinemia than those without hyperbilirubinemia (6.1 versus 4.1 days; P = 0.015). Nine (11.1%) showed development of severe illnesses such as acute respiratory distress syndrome (2 patients), aseptic meningitis (3), and acute renal failure (4). Only one died of acute respiratory distress syndrome. Cases of murine typhus were often found during the summer and had acute febrile hepatitis. Those patients with hyperbilirubinemia tended to have a delayed recovery even with appropriate therapy.

Emergence of vancomycin-resistant Enterococcus bloodstream infections in southern Taiwan.

BACKGROUND: An increased incidence of vancomycin-resistant enterococcal bloodstream infections (VRE BSI) in the United States has been noted in recent years. There were a few reports of VRE BSI in Taiwan. This study is intended to show the epidemiology, clinical features and outcomes of VRE BSI at a medical center in southern Taiwan. METHODS: A retrospective study was conducted from January 1, 2005 to December 31, 2010. All patients with VRE BSI episodes were identified and their medical records were reviewed. RESULTS: A total of 69 episodes of VRE BSI were identified in the study period. The incidence rate increased from 0.01 episodes of VRE BSI/1000 patient-days in 2005 to 0.07 episodes of VRE BSI/1000 patient-days in 2010. The 30-day mortality rate was 52.17% for all patients with VRE BSI. The mortality rate of patients who received in vitro active and inactive antimicrobial therapy for VRE BSI was 40% and 100%, respectively (p < 0.001). Factors associated with mortality were shock [odds ratio (OR) 24.4, 95% confidence interval (CI) 3.6-163.2, p = 0.001], renal failure (OR 90.9, 95% CI 1.9-4404.3, p = 0.02), and underlying liver cirrhosis (OR 12.4, 95% CI 1.2-125.8, p = 0.03). Use of linezolid for VRE BSI showed a trend for lower 30-day mortality than daptomycin therapy (35.5% vs. 56.3%, p = 0.17). CONCLUSION: VRE BSI is increasingly important in the study hospital and is associated with a significant mortality rate. Appropriateness of antimicrobial therapy has a prognostic impact on patients with VRE BSI.

Nontyphoidal Salmonella bacteremia in patients with connective tissue diseases.

BACKGROUND/PURPOSE: Nontyphoidal Salmonella (NTS) is a crucial pathogen in immunocompromised patients, especially those with connective tissue disease (CTD) and corticosteroid or immunosuppressant therapy. The aim of this study is to identify the clinical characteristics and outcomes of patients with CTD and NTS bacteremia, and the clinical variations between systemic lupus erythematosus (SLE) and other CTDs. METHODS: During a 15-year study period, from 1994 to 2009, NTS bacteremia patients were reviewed from the database of clinical microbiology laboratory. Medical records were reviewed for clinical information and only patients with underlying CTD were included. RESULTS: From 1994 to 2009, there were 299 patients with NTS bacteremia. Forty-six (15.4%) patients had certain connective tissue diseases, and SLE was the major CTD, accounting for 73.9% (34) of 46 patients. In comparison with patients without CTD, the patients with CTD were younger (p<0.0001), had a predominance of female gender (p<0.0001), fewer extra-intestinal focal infections (p=0.011), and a lower mortality rate (p=0.008). Overall, there were four fatal cases, accounting for a mortality rate of 8.7% of those afflicted with CTD. The factors of old age (p<0.006), shock at presentation (p=0.033), acute renal failure (p=0.001), and presence of any extra-intestinal focal infection (p<0.0001) were associated with mortality in the univariate analysis. CONCLUSION: Nontyphoidal Salmonella bacteremia causes substantial morbidity and mortality in patients with connective tissue disease, especially in the elderly population. The aggressive detection of extra-intestinal infections may be beneficial.

A simple scoring algorithm predicting vascular infections in adults with nontyphoid Salmonella bacteremia.

BACKGROUND: Nontyphoid Salmonella (NTS) can cause fatal vascular infections. This study aims to establish a predictive scoring algorithm to identify adults aged ≥ 50 years with NTS bacteremia who are at risk for vascular infections. METHODS: There were 358 adults aged ≥ 50 years with NTS bacteremia at 2 medical centers in southern Taiwan included in this study. Multiple logistic regression was used to identify risk factors for imaging-documented vascular infections. The prediction capability of the proposed scoring algorithm was indicated by a receiver operating characteristic curve and measures of sensitivity and specificity. RESULTS: Sixty patients (16.8%) with vascular infections were noted. The 4 risk factors significantly associated with vascular infections-male sex, hypertension, coronary arterial disease, and serogroup C1 infections-were each assigned +1 point to form the NTS vascular infection (NTSVI) score. In contrast, malignancy and immunosuppressive therapy were each assigned -1 point, owing to their negative associations with vascular infections. Based on the proposed NTSVI scoring, the prevalence of vascular infections in patients with ≤ 0, 1, 2, 3, or 4 points was 2.2% (3 of 138 patients), 10.6% (13 of 123 patients), 39.4% (26 of 66 patients), 55.2% (16 of 29 patients), and 100% (2 of 2 patients), respectively (P< .0001). The scoring algorithm shows an area under the curve of 0.83 (95% confidence interval, .78-.89; P < .0001). A cutoff value of +1 represents a high sensitivity (95.0%) and an acceptable specificity (45.3%). CONCLUSIONS: This simple scoring algorithm can be used to identify patients with NTS bacteremia with a high risk of vascular infections. The cost-effectiveness of this algorithm should be further studied.

Prediction of community-onset bacteremia among febrile adults visiting an emergency department: rigor matters.

OBJECTIVES: Bacteremia is a severe bacterial infection with significant mortality and morbidity. Clinical parameters that reliably predict the presence of community-onset bacteremia are less elucidated. METHODS: During 96 randomly selected days between August 2006 and July 2007, a prospective study was conducted to analyze the risk factors of community-onset bacteremia among febrile adults who visited the emergency department (ED) of a medical center. Patients hospitalized in the 30 days prior to the study, patients experiencing consciousness alteration, and nursing facility residents were excluded. RESULTS: The mean age of the 396 febrile adults enrolled in the study was 53.8 years (range, 18-95 years), and 60 (15.2%) patients had true bacteremia, with the predominance of monomicrobial Gram-negative pathogens (42 patients). In a multivariate analysis, several factors were independently associated with community-onset bacteremia, including an age of >65 years (odds ratio [OR], 2.81; 95% confidence interval [CI], 1.25-6.33), the presence of rigor (OR, 13.7; 95% CI, 4.47-42.0) or chills (OR, 6.04; 95% CI, 1.10-32.9), a body temperature >39.9 °C (OR, 2.68; 95% CI, 1.03-6.94), blood urea nitrogen >20 mg/dL (OR, 5.56; 95% CI, 2.03-15.7), a blood urea nitrogen/creatinine ratio >16 (OR, 2.29; 95% CI, 1.03-5.11), and thrombocytopenia (OR, 6.09; 95% CI, 1.84-20.0). After scoring each risk factor, a logistic regression model for the prediction of bacteremia was developed, and the area under the receiver operating characteristic curve was 0.91. CONCLUSIONS: Some easily determined clinical parameters were independently associated with community-onset bacteremia among febrile adults, and the most significant predictor was the presence of rigor. Although the proposed predictive model needs further validation, it may be of use for the early identification of bacteremic episodes in ED practice.

Online sex-seeking, substance use, and risky behaviors in Taiwan: results from the 2010 Asia Internet MSM Sex Survey.

We conducted an online behavioral survey to estimate the prevalence of online sex-seeking and substance use behaviors and to compare risky behaviors among men using different venues to seek sex with men. A cross-sectional online survey, the Asia Internet MSM Sex Survey, was conducted online from January 1 to February 28, 2010. Of the 1,645 participants enrolled from Taiwan, 72.4% reported the Internet as the main way of seeking sexual partners, 73.9% had had sex with partners found online, and 16% had used recreational drugs in the previous 6 months. There was no evidence to suggest that men who looked for sex through the Internet were more likely to engage in unprotected anal intercourse with their casual partners than those using other gay venues. Having had online sex partners in the previous 6 months was significantly associated with being young [adjusted odd ratio (AOR) = 0.97, 95% CI: 0.95-0.99], having had no steady partners in the previous year (AOR = 0.24, 95% CI: 0.15-0.39), having had more than five partners in the previous 6 months (AOR = 4.57, 95% CI: 2.95-7.11), having used recreational drugs in the previous 6 months (AOR = 2.24, 95% CI: 1.30-3.87), and having had an STI in the previous 6 months (AOR = 4.24, 95% CI: 1.59-11.30). In conclusion, because the Internet is a popular meeting place for MSM in Taiwan, effective and targeted prevention programs should be developed to minimize the HIV transmission risk in the Internet era.

A novel rotating electrochemically anodizing process to fabricate titanium oxide surface nanostructures enhancing the bioactivity of osteoblastic cells.

Titanium oxide (TiO(2) ) surface layers with various surface nanostructures (nanotubes and nanowires) have been developed using an anodizing technique. The pore size and length of TiO(2) nanotubes can be tailored by changing the anodizing time and applied voltage. We developed a novel method to transform the upper part of the formed TiO(2) nanotubes into a nanowire-like structure by rotating the titanium anode during anodizing process. The transformation of nanotubes contributed to the preferential chemical dissolution of TiO(2) on the areas with intense interface tension stress. Furthermore, we further compared the effect of various TiO(2) surface nanostructures including flat, nanotubes, and nanowires on bioactive applications. The MG-63 osteoblastic cells cultured on the TiO(2) nanowires exhibited a polygonal shape with extending filopodia and showed highest levels of cell viability and alkaline phosphatase activity (ALP). The TiO(2) nanowire structure formed by our novel method can provide beneficial effects for MG-63 osteoblastic cells in attachment, proliferation, and secretion of ALP on the TiO(2) surface layer.

Distribution and phenotypic and genotypic detection of a metallo-ß-lactamase, CphA, among bacteraemic Aeromonas isolates.

The objectives of the study were to investigate the distribution of cphA-related genes (cphA) encoding a CphA metallo-ß-lactamase (MBL) among 51 consecutive Aeromonas blood isolates and to compare different phenotypic methods for detecting CphA. The presence of cphA was detected by PCR. Four phenotypic methods, the imipenem-EDTA combined disc test, imipenem-EDTA MBL Etest, agar dilution test and modified Hodge test (MHT), were used to detect imipenem susceptibility and MBL production. The results showed that 35 (69%) blood isolates had cphA. All (100%) of 16 Aeromonas aquariorum isolates and 12 Aeromonas veronii isolates, and 4 (80%) of 5 Aeromonas hydrophila isolates, carried cphA, but none of 15 Aeromonas caviae isolates did. With the standard inocula, irrespective of the presence or absence of cphA, all but one (50, 98%) isolates were susceptible to imipenem tested by disc diffusion, Etest and agar dilution (10(4) c.f.u. spot inocula), and did not exhibit MBL production by the imipenem-EDTA combined disc test and MBL Etest. By the agar dilution test using large inocula (10(7) c.f.u.), 34 (97%) of 35 cphA(+) isolates had imipenem MICs of ≥16 µg ml(-1), higher than the susceptible breakpoint (4 µg ml(-1)), and demonstrated positive results for the MHT, while one cphA(+) and all 17 cphA(-) isolates had imipenem MICs of ≤4 µg ml(-1). In conclusion, the distribution of cphA among aeromonads is species-specific, found in A. aquariorum, A. veronii and A. hydrophila, and the MHT may be a phenotypic screening test for CphA production.

Non-typhoidal Salmonella bacteremia among adults: an adverse prognosis in patients with malignancy.

BACKGROUND: Clinical information about non-typhoidal Salmonella (NTS) bacteremia in patients with malignancy has rarely been described. This study investigated clinical characteristics and prognostic variables of patients with malignancy while complicated with NTS bacteremia. METHODS: The study included demographic data, clinical information, and outcome in adults (≥18 years old) with and without malignancy complicated with NTS bacteremia at a medical center from 2000 to 2009. RESULTS: There were 206 patients with NTS bacteremia. The serogroups of NTS isolates included group B (40.2%), group D (30.9%), group C (26.5%), and group E (1.5%). Extraintestinal infections were noted in 66 (32.4%) patients and were mainly endovascular (26/206, 12.7%) or pleuropulmonary (17/206, 8.3%) infections. On multivariate analysis, independent factors for in-hospital mortality included shock (odds ratio [OR] 9.13; 95% confidence interval [CI] 3.81-21.83; p < 0.001), malignancy (OR 8.42; 95% CI 3.12-22.71; p < 0.001), and acute renal failure (OR 2.63; 95% CI 1.11-6.22; p = 0.028). Different clinical presentations and outcome were noted in 74 (36.2%) patients with malignancy and 130 without malignancy. The former had more leucopenia and thrombocytopenia at initial presentation and fewer extraintestinal infections (20.2% vs. 39.2%, p = 0.005), endovascular infections (2.7% vs. 18.5%; p = 0.002), and serovar Choleraesuis (10.8% vs. 27.7%; p = 0.005). An elevated in-hospital mortality rate was noted in patients with malignancy compared to those without malignancy (40.5% vs. 17.7%, p < 0.001). Among patients with malignancy, multivariate analysis revealed that shock was the only independent factor associated with in-hospital mortality (OR 7.52; 95% CI, 2.38-23.80; p = 0.001). CONCLUSION: Malignancy is an adverse prognostic factor in patients with NTS bacteremia. Food safety in patients with malignancy should be emphasized to prevent salmonellosis.

Impact of the nurse-led case management program with retention in care on mortality among people with HIV-1 infection: a prospective cohort study.

BACKGROUND: Long-term retention of patients in care is emerging as an important factor for the mortality among persons with human immunodeficiency virus (HIV) infection. OBJECTIVES: The study was to determine the impact of the case management with retention in care on mortality among HIV infected patients. DESIGN AND SETTINGS: A longitudinal prospective cohort study was conducted at a tertiary referral HIV-designated hospital in Taiwan. PARTICIPANTS: Charts from 1040 patients who had made at least one visit for HIV care at the HIV Clinic in the study hospital in 2009 were abstracted. METHODS: A computerized data collection form was used to retrospectively retrieve the electronic demographic and clinical data generated during each clinic visit. Follow-up ended at death or at the last clinic visit as of December 31, 2009. RESULTS: Less than half (44.2%) of 961 HIV-infected patients were retained for follow-up from 2005 to 2009. Patients who received case management were 4.78 times more likely to remain consistently in care than those who did not receive case management, after controlling for other confounding variables. In the Cox proportional hazard analysis, higher hazards of death were independently associated with older age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.026-1.055), entering care before 2005 (HR: 1.73; 95% CI: 1.035-2.885), low baseline CD4 cell count (HR: 0.997; 95% CI: 0.995-0.998), without antiretroviral therapy (HR: 0.55; 95% CI: 0.334-0.909), irregular attendance of HIV care or loss to follow-up (HR: 0.058; 95% CI: 0.023-0.148), acquisition of HIV infection through sexual contact (HR: 2.95; 95% CI: 1.517-5.746), and irregular attendance or lost to follow-up and did not enrolled in the case management program (HR: 3.76; 95% CI: 1.015-14.777). CONCLUSION: Retention in care is independently predictive of survival, and case management is a mediator affecting retention on survival. Case managers need to identify high risk patients for irregular attendance and to retain them in HIV care in order to maximize their health outcomes.