Background. Patients infected with human immunodeficiency virus (HIV), especially at advanced stages of HIV infection and low CD4+ T-lymphocytes levels, were reported to be less frequently co-infected with Helicobacter pylori than general population, according to literature data. Purpose: to study Helicobacter pylori infection in HIV-positive hosts with digestive complaints. Methods: retrospective, analytical, case-control study (November 2011 - December 2013), upon two groups of patients with gastro-intestinal symptoms tested for Helicobacter pylori stool antigen at the Infectious Diseases Laboratory, Clinical County Hospital Mureş. Group A included 44 HIV-positive patients, group B: 58 HIV-negative subjects. We first compared groups A and B regarding the frequency of Helicobacter pylori infection. Group A was afterwards divided into two sub-groups, according to the status of Helicobacter pylori infection: group A1: 5 Helicobacter pylori-positive subjects, group A2: 39 Helicobacter pylori-negative ones. We collected information regarding CD4+ T-lymphocytes level, HIV-RNA plasma viral load, previous antibiotic and antiretroviral therapy, co-morbidities, comparing A1 and A2 subgroups. Data were processed using GraphPad Prism 5 programme. Results. The frequency of Helicobacter pylori infection was 11.36% among HIV-positive patients and 13.79% in HIV-negative ones, without statistically significant difference. We found no statistically significant differences between subgroups A1 and A2 regarding CD4+ T-lymphocytes level, HIV-RNA plasma viral load, antibiotic / antiretroviral therapy. Conclusions. Though Helicobacter pylori infection may represent one of the causes of gastro-intestinal symptoms in HIV-positive patients, its frequency did not differ to that registered in the general population, in our study.
1. Atherton JC, Blaser MJ. Helicobacter pylori infections. In Kasper DL, Fauci AS. Harrison’s Infectious Diseases. McGraw Hill Medical, NY. 2010;506-11.
2. Fialho ABC, Braga-Neto MB, Guerra EJC, Fialho AMN, Fernandes KC, Sun JLM et al. Low prevalence of H. pylori infection in HIV-positive patients in the Northeast of Brazil. BMC Gastroenterology. 2011 Feb;11:13. DOI: 10.1186/1471-230X-11-13
3. Chiu HM, Wu MS, Hung CC, Shun CT, Lin JT. Low prevalence of Helicobacter pylori but high prevalence of cytomegalovirus-associated peptic ulcer disease in AIDS patients: Comparative study of symptomatic subjects evaluated by endoscopy and CD4+ counts. J Gastroenterol. 2004 Mar;19:423-8.
4. Schiefferstein-Knauer C, Buhk T. Management of side effects. In Hoffmann C, Rockstroh JK. HIV 2012/2013, Medizin Fokus Verlag, Hamburg. 2012;264-7.
5. Olmos M, Araya V, Pskorz E, Quesada EC, Concetti H, Perez H et al. Coinfection: Helicobacter pylori / human immunodeficiency virus. Dig Dis Sci. 2004 Nov- Dec;49(11-12):1836-9. DOI: 10.1007/s10620-004-9580-5
6. Kafil HS, Jahromi FF, Hajikhani B, Pirayeh SN, Aghazadeh M. Screening for the presence of Helicobacter pylori in stool of HIV-positive patients. JAHR. 2011 Apr;3(4):85-7.
7. Șincu NI, Bățagă S, Chiriac C, Țilea B, Zaharia-Kez di I, Incze A, et al. Helicobacter pylori infection in HIV-positive versus HIV-negative patients. Acta Medica Marisiensis. 2012;58(6):454-7.
8. Sulkowski MS. Gastrointestinal and hepatobiliary manifestations of human immunodeficiency virus infection. In Mandell GL, Bennett JE, Dolin R, editors: Mandell, Douglas, and Bennett’s Principles and practice of infectios diseases, 7th edition, Churchill Livingstone Elsevier, Philadelphia. 2010, 1737-44. DOI: 10.1016/ B978-0-443-06839-3.00123-5
9. Welage LS, Carver PL, Revankar S, Pierson C, Kauffman CA. Alterations in gastric acidity in patients infected with human immunodeficiency virus. Clin Infect Dis. 1995 Dec;21(6):1431-8. DOI: 10.1093/clinids/ 21.6.1431
10. Romanelli F, Smith KM, Murphy BS. Does HIV infection alter the incidence or pathology of Helicobacter pylori infection? AIDS Patient Care STDS. 2007 Dec;21(12):908-19. DOI: 10.1089/apc.2006.0215
11. Mach T, Skwara P, Biesiada G, Ciesla A, Macura A. Morphological changes of the upper gastrointestinal tract mucosa and Helicobacter pylori infection in HIV-positive patients with severe immunodeficiency and symptoms of dyspepsia. Med Sci Monit. 2007 Jan;13(1):CR14-9.
12. Lichterfeld M, Lorenz C, Nischalke HD, Scheurlen C, Sauerbruch T, Rockstroh JK. Decreased prevalence of Helicobacter pylori infection in HIV patients with AIDS defining diseases. Z Gastroenterol. 2002;40(1):11-4. DOI: 10.1055/s-2002-19637
13. AliMohamed F, Lule GN, Nyong’o A, Bwayo J, Rana FS. Prevalence of Helicobacter pylori and endoscopic findings in HIV seropositive patients with upper gastrointestinal tract symptoms at Kenyatta National Hospital, Nairobi. East Afr Med J. 2002 May;79(5):226-31.
14. Khalifa MM, Sharaf RR, Aziz RK. Helicobacter pylori: a poor man’s gut pathogen? Gut Pathogens. Gut Pathog. 2010 Mar;2(1):2. DOI: 10.1186/1757-4749-2-2
15. Calvet X, Ramirez Lazaro M-J, Lehours P, Megraud F. Diagnosis and epidemiology of Helicobacter pylori infection. Helicobacter. 2013 Sep;18(s1):5-11. DOI: 10.1111/hel.12071
16. Bhaijee F, Subramony C, Tang SJ, Pepper DJ. Human immunodeficiency virus-associated gastrointestinal disease: common endoscopic biopsy diagnoses. Patholog Res Int. 2011 Apr;2011:247923. DOI: 10.4061/2011/247923
17. Wilcox CM, Saag MS. Gastrointestinal complications of HIV infection: changing priorities in the HAART era. Gut. 2008 Jan;57:861-70. DOI: 10.1136/ gut.2006.103432
19. Nkuize M, De Wit S, Muls V, Arvanitakis M, Buset M. Upper gastrointestinal endoscopic findings in the era of highly active antiretroviral therapy. HIV Medicine. 2010 Feb;11(6):412-7. DOI: 10.1111/j.1468-1293.2009.00807.x