Helicobacter pylori infection rates in dyspeptic Serbian HIV-infected patients compared to HIV-negative controls.

Aleksandra Radovanovic Spurnic,Dubravka Salemovic,Djordje Jevtovic,Tatijana Pekmezovic,Ivana Pesic Pavlovic,Branko Brmbolic,Milos Korac,Zoran Bukumiric,Jovan Ranin,Ivana Milosevic,Giuseppe Vittorio De Socio

doi:10.1371/journal.pone.0248041

Abstract

Helicobacter pylori infection does not belong to the spectrum of opportunistic infections in people living with HIV (PLHIV). To evaluate the Helicobacter pylori infection prevalence rate trends in HIV co-infected individuals in comparison to the HIV-negative population, we compared histopathological findings of H. pylori positive gastritis (gastritis topography and histopathology) between 303 PLHIV and 2642 HIV-negative patients who underwent esophagogastroduodenoscopy (EGD) between 1993 and 2014 due to dyspeptic symptoms. The prevalence of H. pylori infection was significantly higher in HIV-negative controls than in PLHIV (50.2% vs. 28.1%). A significantly positive linear trend of H. pylori co-infection in PLHIV was revealed in the observed period (b = 0.030, SE = 0.011, p = 0.013), while this trend was significantly negative in HIV-negative patients (b = - 0.027, SE = 0.003, p < 0.001). Patients with HIV/H. pylori co-infection had significantly higher CD4+ T cell counts and more often had undetectable HIV viremia, due to successful anti-retroviral therapy (ART). Stomach histopathological findings differed between HIV co-infected and H. pylori mono-infected patients. Our findings confirm that the ART has changed the progression of HIV infection, leading to a significant increase in the prevalence of H. pylori infection in dyspeptic PLHIV over time. Our data also suggests that a functional immune system may be needed for H. pylori-induced human gastric mucosa inflammation.

Highlights

Helicobacter pylori (H. pylori) is the most common bacterial infection in the world [1]
Even though we did not demonstrate any significant changes in two Annual percent change (APC), which converge towards similar prevalence rates during last two years of the observed period, we may speculate that these changes in the two observed linear trends could be related to the gradual anti-retroviral therapy (ART) introduction in Human Immunodeficiency Virus (HIV)-positive patients, as well as the eradication therapy for H. pylori among controls
According to our data, we believe that in the population of HIV infected individuals the linear trend of the slowly rising prevalence of gastritis associated with H. pylori coinfection could be the consequence of slow and steady immune reconstitution ranging from a rather weak mono or dual ART in the beginning to the more potent modern highly active antiretroviral therapy (HAART), resulting in a similar level of H. pylori gastritis development in all our patients

Summary

Introduction

Helicobacter pylori (H. pylori) is the most common bacterial infection in the world [1]. It is estimated that nearly half of the world population harbors this bacteria [2]. Several factors are essential for the infection establishment, and they include environmental, bacterial, and host. Helicobacter pylori infection rates in dyspeptic Serbian HIV-infected patients factors [3, 4].The acute infection is mostly asymptomatic [5]. It has been observed that the prevalence of H. pylori infection varies over time in different geographical regions, even within the same population. The prevalence is rather low in industrialized countries, while it reaches much higher levels in developing and underdeveloped countries, mostly among children. There are no available data for its prevalence in the Republic of Serbia, while in the neighboring Republic of Croatia it is 60.4% [8]

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Results

Discussion

Conclusion