Helicobacter pylori Eradication Failure More Frequent Among Patients With HIV Coinfections

Patients with human immunodeficiency virus (HIV) and Helicobacter pylori (H pylori) coinfections often experienced eradication failure of H pylori, which was associated with antiretroviral exposure, treatment strategy, and lifestyle. These findings from a longitudinal case-control registry study were published in HIV Medicine.

Patients with H pylori treated at University Hospital Saint Pierre in Belgium were recruited for this study. Included patients were classified obese and scheduled for bariatric surgery between 2007 and 2014 or were HIV positive and were recruited between 2006 and 2017. Both groups received H pylori standard triple therapy (S3T).

Between 2017 and 2019, a second group of patients with HIV receiving highly active antiretroviral therapy (HAART) were evaluated by a single specialist who prescribed 1 of 5 possible H pylori eradication therapies on the basis of antibiotic susceptibility.

Participants who were HIV positive (n=258) and negative (n=204) were aged mean 43.4±10.9 and 39.1±12.1 years, 49.2% and 27.5% were men, BMI was 26.2±6.3 and 42.2±5.7 kg/m², and 62.0% and 17.7% were sub-Saharan African, respectively.

Among patients with HIV, 77.9% were HAART-treated, median viral load was 50 (interquartile range [IQR], 20-531) copies/mL, and CD4 lymphocyte count was 527 (IQR, 360-729) cells/mL.

The antibiotic resistance status was 52.6% and 36.5% to metronidazole, 34.8% and 13.2% to levofloxacin, and 17.0% and 10.4% to clarithromycin among the HIV-positive and obese cohorts, respectively.

Treatment failure was more common among the HIV cohort (24.1% vs 8.8%; P <.0001), especially among S3T recipients (25.0% vs 9.1%; P <.0001). Among S3T recipients, failure of antimicrobial susceptibility-guided therapy (34.6% vs 10.1%; P =.0001) was more frequent than empiric-guided (24.0% vs 8.0%; P =.003) compared with the HIV-negative patients, respectively.

Failure of H pylori eradication was increased among patients receiving shorter therapy (odds ratio [OR], 1.992; 95% CI, 1.221-3.250; P =.006) and was decreased among patients who were HIV-negative (OR, 0.304; 95% CI, 0.174-0.534; P <.0001), did not drink alcohol (OR, 0.433; 95% CI, 0.257-0.728; P =.002), and were not on HAART medications (OR, 0.530; 95% CI, 0.306-0.916; P =.02).

Among patients who were HIV-positive and given S3T eradication therapy, failure was decreased among those who were given optimal eradication therapy (adjusted OR [aOR], 0.140; 95% CI, 0.044-0.446; P =.001), not taking HAART medications (aOR, 0.219-0.082-0.580; P =.002), and did not drink alcohol (aOR, 0.387; 95% CI, 0.19-0.837; P =.008).

This study may have been biased, as the cohort groups were unbalanced.

These data indicated patients with HIV and H pylori coinfections were associated with increased eradication failures. Additional study data are needed to assess strategies for determining optimal treatment for patients with HIV coinfections.

Reference

Nkuize M, Vanderpas J, Buset M, Delforge M, Cadière G-B, De Wit S. Failure to eradicate Helicobacter pylori infection is more frequent among HIV-positive patients. HIV Med. Published online March 25, 2021. doi: 10.1111/hiv.13083