Intestinal Colonization with Tropheryma whipplei-Clinical and Immunological Implications for HIV Positive Adults in Ghana.

Kirsten Alexandra Eberhardt,Albert Dompreh,Betty Norman,Fred Stephen Sarfo,Martin Aepfelbacher,Eva-Maria Klupp,Torsten Feldt,Richard Boateng,Richard Odame Phillips,Veronica Di Cristanziano,Edmund Osei Kuffour

doi:10.3390/microorganisms9081781

Abstract

Background: Recent studies demonstrated higher prevalence rates of Tropheryma whipplei (T. whipplei) in HIV positive than in HIV negative subjects. However, associations with the immune status in HIV positive participants were conflicting. Methods: For this cross-sectional study, stool samples of 906 HIV positive and 98 HIV negative individuals in Ghana were tested for T. whipplei. Additionally, sociodemographic parameters, clinical symptoms, medical drug intake, and laboratory parameters were assessed. Results: The prevalence of T. whipplei was 5.85% in HIV positive and 2.04% in HIV negative participants. Within the group of HIV positive participants, the prevalence reached 7.18% in patients without co-trimoxazole prophylaxis, 10.26% in subjects with ART intake, and 12.31% in obese participants. Frequencies of clinical symptoms were not found to be higher in HIV positive T. whipplei carriers compared to T. whipplei negative participants. Markers of immune activation were lower in patients colonized with T. whipplei. Multivariate regression models demonstrated an independent relationship of a high CD4+ T cell count, a low HIV-1 viral load, and an obese body weight with the presence of T. whipplei. Conclusions: Among HIV positive individuals, T. whipplei colonization was associated with a better immune status but not with clinical consequences. Our data suggest that the withdrawal of co-trimoxazole chemoprophylaxis among people living with HIV on stable cART regimen may inadvertently increase the propensity towards colonization with T. whipplei.

Highlights

Tropheryma whipplei (T. whipplei) is the causative agent of Whipple’s disease, a rare systemic infectious disease
Within the group of HIV positive participants, the prevalence varied depending on subgrouping and reached 7.18% in patients without co-trimoxazole prophylaxis, 10.26% in subjects with antiretroviral therapy (ART) intake and 12.31% in obese HIV
Frequencies of clinical symptoms were not found to be higher in HIV positive T. whipplei carriers compared to T. whipplei negative participants

Summary

Introduction

Tropheryma whipplei (T. whipplei) is the causative agent of Whipple’s disease, a rare systemic infectious disease. Classic Whipple’s disease typically involves the gastrointestinal tract and is associated with diverse intra- and extra-intestinal manifestations [1,2,3,4]. The detection of T. whipplei in asymptomatic carriers indicates that colonization is common and that only a minority of infected individuals develop Whipple’s disease upon exposure to this soil microbe [5,6]. Detection rates observed in resource-limited settings are generally higher than in more developed countries [7,8,9,10]. Children are at higher risk of being colonized than adults [6,8,11]. Differences between sample specimens and applied PCR assays might contribute to observed variations [12]

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