Gastric Pathology in HIV-Infected Patients

Abstract

Purpose: Studies have reported a lower prevalence of H. pylori infection in patients infected with the human immunodeficiency virus (HIV) than in the general population; the spectrum of gastric pathology in these patients has not been addressed. Furthermore, many of these studies suffered from small numbers of HIV-infected patients, inadequate or absent control groups, and different detection modalities for H. pylori. This study was designed to compare the prevalence of the most common gastric conditions in a group of HIV-positive subjects and in a large cohort of uninfected age-group matched controls. Methods: From the Miraca Life Sciences database we extracted histopathologic, demographic, and clinical information from all patients with gastric biopsies obtained between January, 2008 and December, 2012. The prevalence of the most common gastric histopathologic diagnoses, evaluated according to the updated Sydney System (normal mucosa, H. pylori gastritis, chronic inactive gastritis [CIG]; reactive gastropathy [RG]; and intestinal metaplasia [IM]) was then compared between patients designated as HIV(+) and presumably HIV(-) subjects within the same age range. Results: There were 186 unique HIV(+) patients (median age 49 years; range 24-83 years; 73.1% male) and 681,582 presumably HIV(-) subjects in the same age group (median age 58 years; range 24-83 years; 38.1% male). HIV(+) patients were younger (p<.0001) and more likely to be male (OR 3.68; 95% CI 2.71-4.98; p<.0001). The prevalence of H. pylori infection was 14.0% in HIV(+) and 10.0% in HIV(-) patients (OR 1.47; 95% CI 0.97-2.22; n.s.). The prevalence of CIG (6.5% versus 5.9%), intestinal metaplasia (4.3% versus 4.0%), and reactive gastropathy (19.4% versus 21.1%) were essentially similar in the two groups. Fundic gland polyps were almost half as common in HIV(+) (4.3%) as in HIV(-) patients (8.0%), but the difference failed to attain statistical significance (OR 0.52; 95% CI 26-1.05; n.s.). Conclusion: The prevalence of the most common gastric histopathologic conditions, whether associated (as CIG and IM) or not (RG) to H. pylori gastritis, was similar in HIV(+) and negative patients. In most previous studies, the prevalence of H. pylori infection in HIV(+) patients was either similar or lower than that of the population from which the sample was drawn. These findings led some investigators to speculate that an intact CD4 population is needed for H. pylori to effectively colonize the human stomach. Our results, based on the highly sensitive and specific immunohistochemical demonstration of organisms in the gastric mucosa, rather than on indirect proofs of infection (as in serology or the urea breath test), suggest that HIV infection does not significantly affect gastric mucosal responses.