Human immunodeficiency virus infection is a challenging disease worldwide. The gastrointestinal tract has long been recognized as a major site of AIDS-related diseases, and researchers have long been seeking the characteristic causing this. A research group in China has found that the prevalence of H pylori infection and peptic ulcer in HIV-positive patients was lower than that of the general population.
Helicobacter pylori has been extensively studied and proven to be the main cause of chronic gastritis and peptic ulcer in the HIV-negative population. Patients with chronic active gastritis have evidence of H pylori infection in over 90% of cases and in 70-100% of those with peptic ulcer disease.
However, the reason for low incidence of H pylori infection in HIV-positive patients was still not very clear. A study examining this issue was recently reported in the November 7 issue of the World Journal of Gastroenterology because of its great significance for AIDS-related diseases.
The article describes 151 patients for gastrointestinal symptoms underwent endoscopic examination in Beijing You¡¯an Hospital, Capital Medical University, the largest referral center for the management of HIV infection and HIV-related complications in China, from January 2003 to March 2006. The HIV-positive patients in the present study, mainly from HeNan province, were infected through illegal blood plasma collection.
One conclusion reported by the investigators is that patients with HIV infection have a low prevalence of H pylori infection and peptic ulcer than that of HIV-negative patients with similar symptoms. The mechanism of chronic active gastritis in HIV-positive patients may be different from HIV-negative group that was closely related to H pylori infection. Various opportunistic infections of Upper gastrointestinal tract is likely to occur in HIV-positive patients with a CD4 lymphocyte counts less than 200/muL, such as CMV infection, Candida esophagitis.
Another interesting conclusion is that 84 % of HIV-positive patients co-infected with HCV and/or HBV infection. Endoscopic examination also revealed findings such as esophago-gastric varices and portal hypertensive gastropathy that was significantly different from previous reports.
The results of this study suggest a different mechanism of peptic ulcerogenesis and a different role of H pylori infection in chronic active gastritis and peptic ulcer in HIV-positive patients.
Reference: Lv FJ, Luo XL, Meng X, Jin R, 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; 13(41): 5492-5496
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