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Helicobacter pylori, HIV and Gastric Hypochlorhydria in the Malawian Population.
PLoS One. 2015; 10(8):e0132043.Plos

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.

Authors+Show Affiliations

Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom.Department of Surgery, College of Medicine, Blantyre, Malawi.Malawi-Liverpool-Wellcome Trust Clinical Research Programme, PO Box 30096, Blantyre 3, Malawi; Department of Medicine, College of Medicine, Blantyre, Malawi.Department of Pathology, Royal Liverpool University Hospital, Liverpool, United Kingdom.Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom.Malawi-Liverpool-Wellcome Trust Clinical Research Programme, PO Box 30096, Blantyre 3, Malawi.Malawi-Liverpool-Wellcome Trust Clinical Research Programme, PO Box 30096, Blantyre 3, Malawi.Department of Surgery, College of Medicine, Blantyre, Malawi.Department of Surgery, College of Medicine, Blantyre, Malawi.Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom.Department of Cellular and Molecular Physiology, University of Liverpool, United Kingdom.Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom.Malawi-Liverpool-Wellcome Trust Clinical Research Programme, PO Box 30096, Blantyre 3, Malawi; Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, United Kingdom.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26244370

Citation

Geraghty, Joe, et al. "Helicobacter Pylori, HIV and Gastric Hypochlorhydria in the Malawian Population." PloS One, vol. 10, no. 8, 2015, pp. e0132043.
Geraghty J, Thumbs A, Kankwatira A, et al. Helicobacter pylori, HIV and Gastric Hypochlorhydria in the Malawian Population. PLoS One. 2015;10(8):e0132043.
Geraghty, J., Thumbs, A., Kankwatira, A., Andrews, T., Moore, A., Malamba, R., Mtunthama, N., Hellberg, K., Kalongolera, L., O'Toole, P., Varro, A., Pritchard, D. M., & Gordon, M. (2015). Helicobacter pylori, HIV and Gastric Hypochlorhydria in the Malawian Population. PloS One, 10(8), e0132043. https://doi.org/10.1371/journal.pone.0132043
Geraghty J, et al. Helicobacter Pylori, HIV and Gastric Hypochlorhydria in the Malawian Population. PLoS One. 2015;10(8):e0132043. PubMed PMID: 26244370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Helicobacter pylori, HIV and Gastric Hypochlorhydria in the Malawian Population. AU - Geraghty,Joe, AU - Thumbs,Alexander, AU - Kankwatira,Anstead, AU - Andrews,Tim, AU - Moore,Andrew, AU - Malamba,Rose, AU - Mtunthama,Neema, AU - Hellberg,Kai, AU - Kalongolera,Lughano, AU - O'Toole,Paul, AU - Varro,Andrea, AU - Pritchard,D Mark, AU - Gordon,Melita, Y1 - 2015/08/05/ PY - 2014/12/19/received PY - 2015/06/09/accepted PY - 2015/8/6/entrez PY - 2015/8/6/pubmed PY - 2016/5/14/medline SP - e0132043 EP - e0132043 JF - PloS one JO - PLoS One VL - 10 IS - 8 N2 - 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/26244370/Helicobacter_pylori_HIV_and_Gastric_Hypochlorhydria_in_the_Malawian_Population_ L2 - https://dx.plos.org/10.1371/journal.pone.0132043 DB - PRIME DP - Unbound Medicine ER -