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Abstract
ABSTRACT
BACKGROUND: The prevalence of Helicobacter pylori (H. pylori) infection and peptic ulcer (PU) in HIV-positive subject was reported to be low in previous studies. The aim of this study was to evaluate the prevalence of H. pylori infection and of PU in relation to absolute CD4 T cells counts in HIV-positive subjects with gastrointestinal symptoms (GI).
MATERIAL AND METHODS: One hundred and twelve age- and sex-matched subjects (56 HIV-positive patients and 56 HIV-negative patients) with GI symptoms were assessed by upper endoscopy and gastric biopsies. The prevalence rate of H. pylori infection was the main variable that was assessed. Patients were classified based on HIV status and CD4 count: In Group A: HIV-positive patients with a CD4 count below 200; group B: HIV-positive patients with a CD4 count from 200 to 499; Group C: HIV-positive patients with a CD4 count higher or equal to 500 and group D: HIV-negative control patients.
RESULTS: The prevalence rate of H. pylori infection in the four groups was as follow: Group A 42.1% (8/19), group B 65.4% (17/20), group C 27.3 % (3/11) and group D 55.4% (31/56). The prevalence rate of PU was 21.05 % (4/19) in group A, 23.07 % (6/26) in group B, 36.4 % (4/11) in group C (p = 0.07), and 17.85 % (10/56) in group D. The prevalence of H. pylori infection in HIV-positive subjects did not differ between patients with and without PU.
Compared with HIV-negative control subjects, HIV-positive subjects with a CD4 count less than 200 had a low prevalence rate of H. pylori infection, this difference was not significant (p = 0.32). The prevalence of PU in HIV-positive subjects with a CD4 count less than 200 was higher compared to that found in HIV-negative control subjects, this difference was not significant (p = 0.97).
CONCLUSION: Although the prevalence of H. pylori infection is low in HIV-positive subjects, the PU is contrarily frequent. The H. pylori infection and PU are not in relation to CD4 counts in HIV-positive subjects.
RÉSUMÉ
OBJECTIF : La prévalence de l’infection à Helicobacter pylori (H. pylori) et de l’ulcère peptique (UP) chez le sujet VIH-positif a été rapportée comme étant basse dans des études précédentes. Le but de cette étude était d’évaluer la prévalence de H. pylori et de l’UP en relation avec le taux absolu de cellules T CD4 chez le sujet VIH-positif avec des symptômes gastro-intestinaux (GI).
MATÉRIELS ET MÉTHODES : Cent douze sujets (56 patients VIH-positif et 56 patients VIH-négatif) appariés selon l’âge et le sexe, avec des symptômes GI ont été évalués par endoscopie digestive haute avec biopsies gastriques. Le taux de prévalence de l’infection à H. pylori était le paramètre principal étudié. Les patients ont été stratifiés sur la base du statut VIH et du taux de CD4: groupe A : patients VIH-positif avec un taux de CD4 <200, groupe B : patients VIH-positif avec un taux de CD4 200-499, groupe C : patients VIH-positif avec un taux de CD4 ≥500, et groupe D : sujets contrôles VIH-négatif.
RÉSULTATS : Le taux de prévalence de l’infection à H. pylori dans les quatre groupes était de : groupe A 42,1 % (8/19), groupe B 65,4 % (17/20), groupe C 27,3% (3/11), et groupe D 55,4 % (31/56). Le taux de prévalence de l’UP était de 21,05% (4/19) dans le groupe A, 23,07 % (6/26) dans le groupe B, 36,4 % (4/11) dans le groupe C (p=0,07), et 17,85 % (10/56) dans le groupe D. La prévalence de l’infection à H. pylori chez les sujets VIH-positif n’était pas différente entre ceux avec ou sans UP. En comparaison avec les sujets contrôles VIH-négatif, les sujets VIH-positif avec un taux de CD4 <200 avaient un taux de prévalence de H. pylori bas, cette différence n’était pas significative (p =0,32). Le taux de prévalence de l’UP chez les sujets VIH-positif avec un taux de CD4 <200 était élevé comparé à celui retrouvé chez les sujets contrôles VIH-négatif, cette différence n’était pas significative (p=0,97).
CONCLUSION : Quoique la prévalence de l’infection à H. pylori soit faible chez les sujets VIH-positif, l’UP par contre est fréquent. L’infection à H. pylori et l’UP ne sont pas associés au taux de CD4 chez les sujets VIH-positif au Cameroun..
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References
- Cacciarelli AG, Marano BJ Jr, Gualtieri NM, Zuretti AR, Torres RA, Starpoli AA, et al. Lower Helicobacter pylori infection and peptic ulcer disease prevalence in patients with AIDS and suppressed CD4 counts. Am J Gastroenterol 1996; 91(9):1783-1784.
- Ali Mohamed F, Lule GN, Nyong'o A, Bwayo J, Rana FS. Prevalence of Helicobacter pylori and endoscopic findings in HIV seropositive patients with upper gastrointestinal tract symptoms at Kenyatta National Hospital, Nairobi. East Afr Med J 2002; 79(5):226–31.
- Chiu HM, Wu MS, Hung CC, Shun CT, Lin JT. Low prevalence of Helicobacter pylori but high prevalence of cytomegalovirus-associated peptic ulcer disease in AIDS patients: Comparative study of symptomatic subjects evaluated by endoscopy and CD4 counts. J Gastroenterol Hepatol. 2004; 19(4):423-428. DOI: 10.1111/j.1440-1746.2003.03278.x.
- Geraghty J, Thumbs A, Kankwatira A, Andrews T, Moore A, Malamba R, et al. Helicobacter pylori, HIV and Gastric hypochlorhydria in the Malawian Population. PLoS One. 2015; 10(8): e0132043. doi: 10.1371/journal.pone.0132043.
- El-Omar EM, Oien K, El-Nujumi A, Gillen D, Wirz A, Dahill S, et al. Helicobacter pylori infection and chronic gastric acid hyposecretion. Gastroenterology. 1997;113(1):15–24.
- Douek DC, Brenchley JM, Betts MR, Ambrozak DR, Hill BJ, Okamoto Y, et al. HIV preferentially infects HIV-specific CD4+ T cells. Nature. 2002;417(6884):95–8.
- Brenchley JM, Schacker TW, Ruff LE, Price DA, Taylor JH, Beilman GJ, et al. CD4+ T cell depletion during all stages of HIV disease occurs predominantly in the gastrointestinal tract. J Exp Med. 2004; 200(6):749–59.
- ONUSIDA. Estimation VIH et SIDA 2014 [en ligne]. Disponible sur : http://www.unaids.org/fr/regionscountries/countries/cameroon (Consulté le 1.11.2015)
- Aabakken L, Rembacken B, Le Moine O, et al. Minimal standard terminology for gastrointestinal endoscopy - MST 3.0. Endoscopy 2009; 41:727-8.
- Bhaijee F, Subramony C, Tang SJ, Pepper DJ. Human immunodeficiency virus-associated gastrointestinal disease: common endoscopic biopsy diagnoses. Patholog Res Int 2011; 2011:247923. doi: 10.4061/2011/247923.
- Varsky CG, Correa MC, Sarmiento N, Bonfanti M, Peluffo G, Dutack A et al. Prevalence and etiology of gastroduodenal ulcer in HIV-positive patients: a comparative study of 497 symptomatic subjects evaluated by endoscopy. Am J Gastroenterol 1998: 93; 935–940. doi:10.1111/j.1572-0241.1998.00282.x
- Ankouane Andoulo F, Noah Noah D, Tagni-Sartre M, Ndjitoyap Ndam EC, Ngu Blackett K. Epidémiologie de l’infection à Helicobacter pylori à Yaoundé: de la particularité à l’énigme Africaine. Pan Afr Med J 2013; 16:115. doi:10.11604/pamj.2013.16.115.3007.
- Fialho ABC, Braga-Neto MB, Guerra EJC, Fialho AMN, Fernandes KC, Sun JLM, et al. Low prevalence of H. pylori infection in HIV-positive patients in the northeast of Brazil. BMC Gastroenterol 2011; 11:13.doi: 10.1186/1471-230X-11-13.
- Lv FJ, Luo XL, XM Rui Jin, Ding HG, Zhang ST. A low prevalence of H pylori and endoscopic findings in HIV-positive Chinese patients with gastrointestinal symptoms. World J Gastroenterol 2007 Nov 7; 13(41): 5492–5496. doi: 10.3748/wjg.v13.i41.5492
- Panos GZ, Xirouchakis E, Tzias V, Charatsis G, Bliziotis IA, Doulgeroglou V, Margetis N, Falagas ME. Helicobacter pylori infection in symptomatic HIV-seropositive and -seronegative patients: a case-control study. AIDS Res Hum Retroviruses. 2007; 23:709–712.
- Fabris P, Pilotto A, Bozzola L, Tositti G, Soffiati G, Manfrin V, et al. Serum pepsinogen and gastrin levels in HIV-positive patients: relationship with CD4+ cell count and Helicobacter pylori infection. Aliment Pharmacol Ther. 2002; 16(4):807–11.
- Lake-Bakaar G, Quadros E, Beidas S, Elsakr M, Tom W, Wilson DE, et al. Gastric secretory failure in patients with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1988; 109(6):502–4.
- Welage LS, Carver PL, Revankar S, Pierson C, Kauffman CA. Alterations in gastric acidity in patients infected with human immunodeficiency virus. Clin Infect Dis. 1995; 21(6):1431–8.
- Shaffer RT, La Hatte LJ, Kelly JW, Kadakia S, Carrougher JG, Keate RF, Starnes EC: Gastric acid secretion in HIV-1 infection. Am J Gastroenterol 1992, 12:1777–80
References
Cacciarelli AG, Marano BJ Jr, Gualtieri NM, Zuretti AR, Torres RA, Starpoli AA, et al. Lower Helicobacter pylori infection and peptic ulcer disease prevalence in patients with AIDS and suppressed CD4 counts. Am J Gastroenterol 1996; 91(9):1783-1784.
Ali Mohamed F, Lule GN, Nyong'o A, Bwayo J, Rana FS. Prevalence of Helicobacter pylori and endoscopic findings in HIV seropositive patients with upper gastrointestinal tract symptoms at Kenyatta National Hospital, Nairobi. East Afr Med J 2002; 79(5):226–31.
Chiu HM, Wu MS, Hung CC, Shun CT, Lin JT. Low prevalence of Helicobacter pylori but high prevalence of cytomegalovirus-associated peptic ulcer disease in AIDS patients: Comparative study of symptomatic subjects evaluated by endoscopy and CD4 counts. J Gastroenterol Hepatol. 2004; 19(4):423-428. DOI: 10.1111/j.1440-1746.2003.03278.x.
Geraghty J, Thumbs A, Kankwatira A, Andrews T, Moore A, Malamba R, et al. Helicobacter pylori, HIV and Gastric hypochlorhydria in the Malawian Population. PLoS One. 2015; 10(8): e0132043. doi: 10.1371/journal.pone.0132043.
El-Omar EM, Oien K, El-Nujumi A, Gillen D, Wirz A, Dahill S, et al. Helicobacter pylori infection and chronic gastric acid hyposecretion. Gastroenterology. 1997;113(1):15–24.
Douek DC, Brenchley JM, Betts MR, Ambrozak DR, Hill BJ, Okamoto Y, et al. HIV preferentially infects HIV-specific CD4+ T cells. Nature. 2002;417(6884):95–8.
Brenchley JM, Schacker TW, Ruff LE, Price DA, Taylor JH, Beilman GJ, et al. CD4+ T cell depletion during all stages of HIV disease occurs predominantly in the gastrointestinal tract. J Exp Med. 2004; 200(6):749–59.
ONUSIDA. Estimation VIH et SIDA 2014 [en ligne]. Disponible sur : http://www.unaids.org/fr/regionscountries/countries/cameroon (Consulté le 1.11.2015)
Aabakken L, Rembacken B, Le Moine O, et al. Minimal standard terminology for gastrointestinal endoscopy - MST 3.0. Endoscopy 2009; 41:727-8.
Bhaijee F, Subramony C, Tang SJ, Pepper DJ. Human immunodeficiency virus-associated gastrointestinal disease: common endoscopic biopsy diagnoses. Patholog Res Int 2011; 2011:247923. doi: 10.4061/2011/247923.
Varsky CG, Correa MC, Sarmiento N, Bonfanti M, Peluffo G, Dutack A et al. Prevalence and etiology of gastroduodenal ulcer in HIV-positive patients: a comparative study of 497 symptomatic subjects evaluated by endoscopy. Am J Gastroenterol 1998: 93; 935–940. doi:10.1111/j.1572-0241.1998.00282.x
Ankouane Andoulo F, Noah Noah D, Tagni-Sartre M, Ndjitoyap Ndam EC, Ngu Blackett K. Epidémiologie de l’infection à Helicobacter pylori à Yaoundé: de la particularité à l’énigme Africaine. Pan Afr Med J 2013; 16:115. doi:10.11604/pamj.2013.16.115.3007.
Fialho ABC, Braga-Neto MB, Guerra EJC, Fialho AMN, Fernandes KC, Sun JLM, et al. Low prevalence of H. pylori infection in HIV-positive patients in the northeast of Brazil. BMC Gastroenterol 2011; 11:13.doi: 10.1186/1471-230X-11-13.
Lv FJ, Luo XL, XM Rui Jin, Ding HG, Zhang ST. A low prevalence of H pylori and endoscopic findings in HIV-positive Chinese patients with gastrointestinal symptoms. World J Gastroenterol 2007 Nov 7; 13(41): 5492–5496. doi: 10.3748/wjg.v13.i41.5492
Panos GZ, Xirouchakis E, Tzias V, Charatsis G, Bliziotis IA, Doulgeroglou V, Margetis N, Falagas ME. Helicobacter pylori infection in symptomatic HIV-seropositive and -seronegative patients: a case-control study. AIDS Res Hum Retroviruses. 2007; 23:709–712.
Fabris P, Pilotto A, Bozzola L, Tositti G, Soffiati G, Manfrin V, et al. Serum pepsinogen and gastrin levels in HIV-positive patients: relationship with CD4+ cell count and Helicobacter pylori infection. Aliment Pharmacol Ther. 2002; 16(4):807–11.
Lake-Bakaar G, Quadros E, Beidas S, Elsakr M, Tom W, Wilson DE, et al. Gastric secretory failure in patients with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1988; 109(6):502–4.
Welage LS, Carver PL, Revankar S, Pierson C, Kauffman CA. Alterations in gastric acidity in patients infected with human immunodeficiency virus. Clin Infect Dis. 1995; 21(6):1431–8.
Shaffer RT, La Hatte LJ, Kelly JW, Kadakia S, Carrougher JG, Keate RF, Starnes EC: Gastric acid secretion in HIV-1 infection. Am J Gastroenterol 1992, 12:1777–80