Limits...
Helicobacter pylori, HIV and Gastric Hypochlorhydria in the Malawian Population.

Geraghty J, Thumbs A, Kankwatira A, Andrews T, Moore A, Malamba R, Mtunthama N, Hellberg K, Kalongolera L, O'Toole P, Varro A, Pritchard DM, Gordon M - PLoS ONE (2015)

Bottom Line: H. pylori and HIV co-infection was more strongly associated with hypochlorhydria (OR 6.25, [1.33-29.43], p=0.020) than either infection alone, suggesting an additive effect of co-infection.Only three patients had histological evidence of gastric atrophy, of which only one was HIV-infected.The mechanism of this apparent additive effect between HIV and H. pylori remains unclear, but appears to be related to chronic pangastritis rather than gastric atrophy, and associated with hypergastrinaemia in HIV-infected individuals.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom.

ABSTRACT

Background: HIV and Helicobacter pylori are common chronic infections in sub-Saharan Africa. Both conditions can predispose to gastric hypochlorhydria that may be a risk factor for enteric infections and reduced drug absorption. We have investigated to what extent HIV and H. pylori infections are associated with hypochlorhydria in a Malawian cohort of patients undergoing endoscopy.

Methods: 104 sequential symptomatic adults referred for gastroscopy at Queen Elizabeth Central Hospital, Blantyre, Malawi, had blood taken for rapid HIV testing and fasting serum gastrin analysis. Gastric fluid was aspirated for pH testing, and gastric biopsies were taken.

Results: After 9/104 HIV-infected patients who were already established on anti-retroviral therapy were excluded, 17/95 (25.0%) were seropositive for untreated HIV, and 68/95 (71.6%) patients were H. pylori positive by histology. Hypochlorhydria (fasting gastric pH>4.0) was present in 55.8% (53/95) of patients. H. pylori infection was significantly associated with hypochlorhydria (OR 2.91, [1.02-7.75], p=0.046). While single infection with HIV was not significantly independently associated with hypochlorhydria. H. pylori and HIV co-infection was more strongly associated with hypochlorhydria (OR 6.25, [1.33-29.43], p=0.020) than either infection alone, suggesting an additive effect of co-infection. HIV infection was associated with higher serum gastrin levels (91.3 pM vs. 53.1 pM, p=0.040), while H. pylori infection was not (63.1 pM vs. 55.1 pM, p=0.610). Irrespective of H. pylori and HIV status, most patients (>90%) exhibited pangastritis. Only three patients had histological evidence of gastric atrophy, of which only one was HIV-infected.

Conclusion: H. pylori infection was associated with fasting hypochlorhydria, while HIV was not independently associated. HIV and H. pylori co-infection, however, was more strongly associated with hypochlorhydria than H. pylori infection alone. The mechanism of this apparent additive effect between HIV and H. pylori remains unclear, but appears to be related to chronic pangastritis rather than gastric atrophy, and associated with hypergastrinaemia in HIV-infected individuals.

No MeSH data available.


Related in: MedlinePlus

The scatterplot displays the absolute pH values for the four groups in relation to H.pylori and HIV infection status.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4526546&req=5

pone.0132043.g001: The scatterplot displays the absolute pH values for the four groups in relation to H.pylori and HIV infection status.

Mentions: In a binary logistic regression analysis, infection with H. pylori alone was associated with a significantly increased OR for hypochlorhydria (OR 2.81 (1.02–7.75), p = 0.046) compared to uninfected individuals, (Table 5). However, the highest and most significant risk for hypochlorhydria was seen in patients who were co-infected with H. pylori and HIV, OR = 6.25 (1.33–29.43) (p = 0.020) (Table 6). The mean gastric pH for uninfected patients was 3.8 (CI: 2.0), for patients only infected with H. pylori it was 4.9 (CI: 2.5) and for patients only infected with HIV it was 5.0 (CI: 2.9). For patients co-infected with HIV and H pylori it was 5.8 (CI: 2.4) (Fig 1), but there were no statistically significant differences between these groups.


Helicobacter pylori, HIV and Gastric Hypochlorhydria in the Malawian Population.

Geraghty J, Thumbs A, Kankwatira A, Andrews T, Moore A, Malamba R, Mtunthama N, Hellberg K, Kalongolera L, O'Toole P, Varro A, Pritchard DM, Gordon M - PLoS ONE (2015)

The scatterplot displays the absolute pH values for the four groups in relation to H.pylori and HIV infection status.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526546&req=5

pone.0132043.g001: The scatterplot displays the absolute pH values for the four groups in relation to H.pylori and HIV infection status.
Mentions: In a binary logistic regression analysis, infection with H. pylori alone was associated with a significantly increased OR for hypochlorhydria (OR 2.81 (1.02–7.75), p = 0.046) compared to uninfected individuals, (Table 5). However, the highest and most significant risk for hypochlorhydria was seen in patients who were co-infected with H. pylori and HIV, OR = 6.25 (1.33–29.43) (p = 0.020) (Table 6). The mean gastric pH for uninfected patients was 3.8 (CI: 2.0), for patients only infected with H. pylori it was 4.9 (CI: 2.5) and for patients only infected with HIV it was 5.0 (CI: 2.9). For patients co-infected with HIV and H pylori it was 5.8 (CI: 2.4) (Fig 1), but there were no statistically significant differences between these groups.

Bottom Line: H. pylori and HIV co-infection was more strongly associated with hypochlorhydria (OR 6.25, [1.33-29.43], p=0.020) than either infection alone, suggesting an additive effect of co-infection.Only three patients had histological evidence of gastric atrophy, of which only one was HIV-infected.The mechanism of this apparent additive effect between HIV and H. pylori remains unclear, but appears to be related to chronic pangastritis rather than gastric atrophy, and associated with hypergastrinaemia in HIV-infected individuals.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom.

ABSTRACT

Background: HIV and Helicobacter pylori are common chronic infections in sub-Saharan Africa. Both conditions can predispose to gastric hypochlorhydria that may be a risk factor for enteric infections and reduced drug absorption. We have investigated to what extent HIV and H. pylori infections are associated with hypochlorhydria in a Malawian cohort of patients undergoing endoscopy.

Methods: 104 sequential symptomatic adults referred for gastroscopy at Queen Elizabeth Central Hospital, Blantyre, Malawi, had blood taken for rapid HIV testing and fasting serum gastrin analysis. Gastric fluid was aspirated for pH testing, and gastric biopsies were taken.

Results: After 9/104 HIV-infected patients who were already established on anti-retroviral therapy were excluded, 17/95 (25.0%) were seropositive for untreated HIV, and 68/95 (71.6%) patients were H. pylori positive by histology. Hypochlorhydria (fasting gastric pH>4.0) was present in 55.8% (53/95) of patients. H. pylori infection was significantly associated with hypochlorhydria (OR 2.91, [1.02-7.75], p=0.046). While single infection with HIV was not significantly independently associated with hypochlorhydria. H. pylori and HIV co-infection was more strongly associated with hypochlorhydria (OR 6.25, [1.33-29.43], p=0.020) than either infection alone, suggesting an additive effect of co-infection. HIV infection was associated with higher serum gastrin levels (91.3 pM vs. 53.1 pM, p=0.040), while H. pylori infection was not (63.1 pM vs. 55.1 pM, p=0.610). Irrespective of H. pylori and HIV status, most patients (>90%) exhibited pangastritis. Only three patients had histological evidence of gastric atrophy, of which only one was HIV-infected.

Conclusion: H. pylori infection was associated with fasting hypochlorhydria, while HIV was not independently associated. HIV and H. pylori co-infection, however, was more strongly associated with hypochlorhydria than H. pylori infection alone. The mechanism of this apparent additive effect between HIV and H. pylori remains unclear, but appears to be related to chronic pangastritis rather than gastric atrophy, and associated with hypergastrinaemia in HIV-infected individuals.

No MeSH data available.


Related in: MedlinePlus