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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 serum gastrin (pM) levels for the four groups in relation to H.pylori and HIV infection status.
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pone.0132043.g002: The scatterplot displays the serum gastrin (pM) levels for the four groups in relation to H.pylori and HIV infection status.

Mentions: The mean fasting serum gastrin concentration was 61pM (sd 69.1) with a range between 9–540pM. As anticipated, patients with hypochlorhydria had significantly higher serum gastrin concentrations (77 vs. 41, p = 0.028). The mean fasting serum gastrin concentration for patients with H. pylori infection (63.1pM) was not significantly different from that in H. pylori negative patients (55.1pM, p = 0.610). However in patients with HIV infection, serum gastrin concentrations were significantly higher than in HIV-uninfected individuals (91.3 vs. 53.1, p = 0.040). Mean serum gastrin concentration in co-infected individuals was even higher at 105pM (sd 141). While the mean gastrin level was highest in this co-infected group (H.pylori +ve HIV +ve), there were no significant differences seen between the uninfected, singly-infected and co-infected groups (Fig 2).


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 serum gastrin (pM) levels 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.g002: The scatterplot displays the serum gastrin (pM) levels for the four groups in relation to H.pylori and HIV infection status.
Mentions: The mean fasting serum gastrin concentration was 61pM (sd 69.1) with a range between 9–540pM. As anticipated, patients with hypochlorhydria had significantly higher serum gastrin concentrations (77 vs. 41, p = 0.028). The mean fasting serum gastrin concentration for patients with H. pylori infection (63.1pM) was not significantly different from that in H. pylori negative patients (55.1pM, p = 0.610). However in patients with HIV infection, serum gastrin concentrations were significantly higher than in HIV-uninfected individuals (91.3 vs. 53.1, p = 0.040). Mean serum gastrin concentration in co-infected individuals was even higher at 105pM (sd 141). While the mean gastrin level was highest in this co-infected group (H.pylori +ve HIV +ve), there were no significant differences seen between the uninfected, singly-infected and co-infected groups (Fig 2).

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