PREVALENCE OF HELICOBACTER PYLORI AND ENDOSCOPIC FINDINGS IN HIV SEROPOSITIVE PATIENTS WITH UPPER GASTROINTESTINAL TRACT SYMPTOMS AT KENYATTA NATIONAL HOSPITAL, NAIROBI

Abstract

Background: Human immunodeficiency virus (HIV) seropositive patients frequently
experience upper gastrointestinal tract (GIT) symptoms that cause considerable morbidity
and are due to multiple aetiologies. The role of Helicobacter pylori gastric mucosal infection
in HIV related upper GIT morbidity is unclear. No data exist on the prevalence of H.pylori
gastric mucosal infection and upper gastrointestinal endoscopic findings in HIV seropositive
patients at the Kenyatta National Hospital.
Objectives: The aim of the study was to determine the prevalence of H. pylori gastric mucosal
infection and the pattern of upper gastrointestinal endoscopic findings in HIV seropositive
patients.
Design: A hospital-based prospective case-control study.
Setting: Kenyatta National Hospital, Endoscopy Unit.
Subjects: Fifty two HIV seropositive patients with upper GIT symptoms were recruited (as
well as 52 HIV seronegative age and gender matched controls).
Intervention: Both cases and control subjects underwent upper GIT endoscopy and biopsies
were taken according to a standard protocol. H. pylori detection was done by the rapid urease
test and histology, and H. pylori gastric mucosal infection was considered to be present in the
presence of a positive detection by both tests; biopsies were also taken for tissue diagnosis and
CD4+ peripheral Iymphocyte counts were determined using flow cytometry.
Results: H. pylori prevalence was 73.1% [95% CI 59.9-83.8] in HIV positive subjects and
84.6% [95% CI 72.9-92.6] in HIV negative controls (p=0.230). Prevalence of H. pylori
decreased with decreasing peripheral CD4+ Iymphocyte counts. Median CD4+ Iymphocyte
count was 67 cells per cubic millimetre in HIV positive patients. On endoscopy, the most
common lesion in HIV positive patients was oesophageal candidiasis (occurring in 51.9%),
which was often associated with presence of oral candidiasis and, together with erosions,
ulcers and nodules in the oesophagus, occurred exclusively in these patients. A few cases of
cytomegalovirus and herpes simplex oesophagitis were seen, as were cases of upper GIT
Kaposi’s sarcoma, and one gastric Iymphoma.
Conclusions: H. pylori prevalence was not significantly different between HIV positive and
HIV negative subjects, and decreased in HIV positive subjects with decreasing CD4+ cell
counts. Oesophageal candidiasis was the most important endoscopic finding in HIV positive
patients and was often associated with oral thrush.