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What is the overlap between HIV and shigellosis epidemics in England: further evidence of MSM transmission?
  1. Keerthi Mohan1,
  2. Matthew Hibbert1,
  3. Graeme Rooney1,
  4. Malcolm Canvin1,
  5. Tristan Childs1,
  6. Claire Jenkins2,
  7. Ian Simms1,
  8. Peter Kirwan1,
  9. Valerie Delpech1,
  10. Zheng Yin1,
  11. Gwenda Hughes1,
  12. Nigel Field1,3
  1. 1Department of HIV and STI, National Infection Service, Public Health England, London, UK
  2. 2Gastrointestinal Infection Reference Service, Microbiology Services Centre, National Infection Service, Public Health England, London, UK
  3. 3Research Department of Infection and Population Health, University College London, London, UK
  1. Correspondence to Dr Keerthi Mohan, National Infection Service, Public Health England, London NW9 5EQ, UK; kitty.mohan{at}nhs.net

Abstract

Background Evidence suggests that sexual transmission between men has replaced foreign travel as the predominant mode of Shigella transmission in England. However, sexuality and HIV status are not routinely recorded for laboratory-reported Shigella, and the role of HIV in the Shigella epidemic is not well understood.

Methods The Modular Open Laboratory Information System containing all Shigella cases reported to Public Health England (PHE) and the PHE HIV and AIDS Reporting System holding all adults living with diagnosed HIV in England were matched using a combination of Soundex code, date of birth and gender.

Results From 2004 to 2015, 88 664 patients were living with HIV, and 10 269 Shigella cases were reported in England; 9% (873/10 269) of Shigella cases were diagnosed with HIV, of which 93% (815/873) were in men. Shigella cases without reported travel history were more likely to be living with HIV than those who had travelled (14% (751/5427) vs 3% (134/4854); p<0.01). From 2004 to 2015, the incidence of Shigella in men with HIV rose from 47/100 000 to 226/100 000 (p<0.01) peaking in 2014 at 265/100 000, but remained low in women throughout the study period (0–24/100 000). Among Shigella cases without travel and with HIV, 91% (657/720) were men who have sex with men (MSM). HIV preceded Shigella diagnosis in 86% (610/720), and 65% (237/362) had an undetectable viral load (<50 copies/mL).

Discussion We observed a sustained increase in the national rate of shigellosis in MSM with HIV, who may experience more serious clinical disease. Sexual history, HIV status and STI risk might require sensitive investigation in men presenting with gastroenteritis.

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Footnotes

  • Handling editor Jackie A Cassell

  • Contributors KM, VD, ZY, GH and NF conceived this article. KM wrote the first draft with further contributions from MH, VD, GH, IS, CJ, PK and NF. KM did the literature review. MH, TC, PK and ZY managed data and undertook data cleaning and linkage. KM undertook the statistical analysis with support from MH, GR, MC, TC, PK and NF. All authors interpreted data, reviewed successive drafts and approved the final version of the article.

  • Funding Undertaken as part of PHE-funded public health surveillance.

  • Competing interests None declared.

  • Ethics approval No individual patient consent was required or sought as PHE has authority to handle patient for public health monitoring and infection control under section 251 of the UK National Health Service Act of 2006 (previously section 60 of the Health and Social Care Act of 2001).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The study used national surveillance data sets held by PHE.

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