1. Treatment of HIV infection in IMSUT hospital:Statistical characteristics of HIV infected pa-tients in IMSUT hospital this year

Tomohiko Koibuchi, Michiko Koga1, HidenoriSato, Lay Ahyoung Lim, Eisuke Adachi, TadashiKikuchi, Takashi Odawara, Hiroshi Yotsuyanagi1:1Division of Infectious Diseases, The AdvancedClinical Research Center,

23 new patients with HIV-1 infection visited toour hospital this year (from January 1 to December31, 2018), and 555 patients in total are under medi-cal management in our outpatient clinic. The totalnumber of HIV-infected in-patients during 2018

was 27. The number of total patients declined in1997, as shown in Fig. 1, because a part of patientsas well as medical stuffs moved to newly estab-lished AIDS Clinical Center in International Medi-cal Center of Japan. However, the number of pa-tients started to increase again after 1998 in accor-dance with Japanese statistics of HIV-infected pa-tients (Fig. 1). Anti-retroviral therapy (ART) hasbeen introduced to 551 HIV-infected patients in ourhospital, and most of their HIV viral loads havebeen well controlled. After one year of ART, the vi-ral loads become less than 100 copies/ml in 99.1％of HIV-infected patients in our outpatient clinic,presumably underscored by the change in themethod of quantitative HIV-RNA assay. Conse-

IMSUT Hospital

Department of Infectious Diseases andApplied Immunology感染免疫内科

Hea , Professor Hiroshi Yotsuyanagi, M.D., D.M.Sc.Senior Assistant Professor Tomohiko Koibuchi, M.D., D.M.Sc.Assistant Professor Michiko Koga, M.D., D.M.ScAssistant Professor isuke A achi, M.D., D.M.Sc.

教 授 博士（医学） 四 柳 宏＊1

講 師 博士（医学） 鯉 渕 智 彦助 教 博士（医学） 古 賀 道 子＊1

助 教 博士（医学） 安 達 英 輔

【兼務】＊1Division of Infectious Diseases, The Advanced Clinical Research Center（先端医療研究センター感染症分野）

Founded in 1981, Department of Infectious Diseases and Applied Immunology(DIDAI) started HIV clinic in 1986. In 2018, 23 new patients with HIV infectionhave visited to our hospital and 555 patients in total are currently under our clini-cal management. The total number of in-patients with HIV-infection during 2018was 27, several beds in our ward have been constantly occupied by patients withnot only HIV-infection but also other infectious diseases. Since the number of thestaff members of DIDAI is too small to care both outpatients and in-patients, mem-bers of the Division of Infectious Diseases and the Department of Infectious Dis-ease Control join the clinic. IMSUT hospital provides the most up-to-date medicaltreatment to HIV-infected patients in Japan. DIDAI is also a treatment center in Ja-pan for international infectious diseases such as malaria and dengue fever.

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quently, the patients are able to maintain good con-dition as long as they keep excellent drug adher-ence rates. The clinical management of HIV-infectedpatients have been changing from how to treat op-portunistic infections into how to control patientswith ART.

2. Creating Practice uidelines for Treatment ofHIV-infected Patients in apan

Tomohiko Koibuchi, Michiko Koga1, HidenoriSato, Lay Ahyoung Lim, Eisuke Adachi, TadashiKikuchi, Takashi Odawara, Hiroshi Yotsuyanagi1:1Division of Infectious Diseases, The AdvancedClinical Research Center

The Japanese guidelines for treatment of HIV-in-fected patients have been established since 1998with support from Ministry of Health, Labor andWelfare. The representatives from our departmenthave played critical roles in development of thecurrent practice guidelines in Japan. It is vital tocreate practice guidelines that are specific for theunique genetic and social backgrounds of the HIV-infected population in Japan. In collaboration withother Japanese HIV-experts, the physicians fromour department update the practice guidelines an-nually, as we deem necessary. The guidelines areavailable at http://www.haart-support.jp/guideline.htm and used widely by Japanese clinicians. Theyhave been viewed 22,081 times in 2018 on the web-site. In Japan, where the number of HIV-experts arelimited compared to other countries, the practice

guidelines have substantially improved the stan-dard of care for the HIV-infected patients in ourcountry.

3. Treatment and Clinical Research of TropicalDiseases in IMSUT hospital

Tomohiko Koibuchi, Michiko Koga1, HidenoriSato, Lay Ahyoung Lim, Eisuke Adachi, TadashiKikuchi, Takashi Odawara, Hiroshi Yotsuyanagi1:1Division of Infectious Diseases, The AdvancedClinical Research Center

Dozens of important medicines essential for treatment of tropical or parasitic diseases are not licensed inJapan. For instance, artesunate and injectable qui-nine for falciparum malaria, pyrimethamine andsulfadiazine for toxoplasmosis, etc. are not licensed.Research Group on Chemotherapy of Tropical Dis-eases, Research on Publicly Essential Drugs andMedical Devices, Grant from the Ministry ofHealth, Labour and Welfare had been establishedto cope with this situation. We are the medical in-stitution of the research group using these orphandrugs if needed, and colleting clinical data. Also,we have clinics for overseas travelers. This year,more than one hundred overseas travelers visitedour clinic. The reasons of their visit included pre-scription of malaria prophylaxis, hepatitis A/B vac-cination, other general health consultation, or treat-ment of tropical diseases such as malaria, intestinalamebiasis, post-exposure prophylaxis of rabies andso on.

Publications

1. Hirano M, Ota Y, Koibuchi T, Takei T, TakedaR, Kawamata T, Yokoyama K, Uchimaru K,

Yotsuyanagi H, Imai Y, Tojo A. Nested polym-erase chain reaction with specific primers for

Figure 1. Number of HIV-infected outpatients in IMSUT Hospital

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Mucorales in the serum of patients with hema-tological malignancies. Jpn J Infect Dis. 2018 Dec25. doi: 10.7883/yoken. JJID. 2018. 379.

2. Adachi E, Miharu Y, Suzuki M, Yotsuyanagi H.Imported Tungiasis in a Non-endemic Country.Intern Med. 2018; 57: 3497-3498.

3. Yanagisawa N, Muramatsu T, Koibuchi T, InuiA, Ainoda Y, Naito T, Nitta K, Ajisawa A,Fukutake K, Iwamoto A, Ando M. Prevalence ofChronic Kidney Disease and Poor DiagnosticAccuracy of Dipstick Proteinuria in Human Im-munodeficiency Virus-Infected Individuals: AMulticenter Study in Japan. Open Forum InfectDis. 2018 Sep 5; 5(10) ofy 216.

4. Hirose J, Takedani H, Nojima M, Koibuchi T.Risk factors for postoperative complications oforthopedic surgery in patients with hemophilia:Second report. J Orthop. 2018; 15: 558-562.

5. Komeno Y, Ota Y, Koibuchi T, Imai Y, Iihara K,Ryu T. Secondary Syphilis with Tonsillar andCervical Lymphadenopathy and a PulmonaryLesion Mimicking Malignant Lymphoma. Am JCase Rep. 2018; 19: 238-243.

6. Nakamura-Uchiyama F, Katanami Y, Kikuchi T,Takaya S, Kutsuna S, Kobayashi T, Mizuno Y,Hasegawa T, Koga M, Yoshimura Y, HasegawaC, Kato Y, Kimura M, Maruyama H; ResearchGroup on Chemotherapy of Tropical Diseases,Japan. Retrospective observational study of theuse of artemether-lumefantrine in the treatmentof malaria in Japan. Travel Med Infect Dis. 2018;22: 40-45.

7. Ikeda H, Watanabe T, Matsumoto N, Hiraishi T,Nakano H, Noguchi Y, Hattori N, Shigefuku R,Yamashita M, Nakahara K, Matsunaga K, OkuseC, Yotsuyanagi H, Tanaka A, Suzuki M, Itoh F.Daclatasvir and asunaprevir improves health-re-lated quality of life in Japanese patients infected

with hepatitis C virus. JGH Open. 2018; 2: 87-92.8. Okushin K, Tsutsumi T, Ikeuchi K, Kado A,

Enooku K, Fujinaga H, Moriya K, YotsuyanagiH, Koike K. Helicobacter pylori infection andliver diseases: Epidemiology and insights intopathogenesis. World J Gastroenterol. 2018; 24:3617-3625.

9. Wakasugi H, Takahashi H, Niinuma T, KitajimaH, Oikawa R, Matsumoto N, Takeba Y, OtsuboT, Takagi M, Ariizumi Y, Suzuki M, Okuse C,Iwabuchi S, Nakano M, Akutsu N, Kang JH,Matsui T, Yamada N, Sasaki H, Yamamoto E,Kai M, Sasaki Y, Sasaki S, Tanaka Y,Yotsuyanagi H, Tsutsumi T, Yamamoto H, Tok-ino T, Nakase H, Suzuki H, Itoh F. Dysregula-tion of miRNA in chronic hepatitis B is associ-ated with hepatocellular carcinoma risk afternucleos(t)ide analogue treatment. Cancer Lett.2018; 434: 91-100.

10. Enooku K, Kondo M, Fujiwara N, Sasako T, Shi-bahara J, Kado A, Okushin K, Fujinaga H,Tsutsumi T, Nakagomi R, Minami T, Sato M,Nakagawa H, Kondo Y, Asaoka Y, Tateishi R,Ueki K, Ikeda H, Yoshida H, Moriya K,Yotsuyanagi H, Kadowaki T, Fukayama M,Koike K. Hepatic IRS1 and b-catenin expressionis associated with histological progression andovert diabetes emergence in NAFLD patients. JGastroenterol. 2018; 53: 1261-1275.

11. Sasako T, Ohsugi M, Kubota N, Itoh S, OkazakiY, Terai A, Kubota T, Yamashita S, NakatsukasaK, Kamura T, Iwayama K, Tokuyama K,Kiyonari H, Furuta Y, Shibahara J, FukayamaM, Enooku K, Okushin K, Tsutsumi T, TateishiR, Tobe K, Asahara H, Koike K, Kadowaki T,Ueki K. Hepatic Sdf2l1 controls feeding-inducedER stress and regulates metabolism. Nat Com-mun. 2019 in press

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