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.
OBJECTIVE
The role of Helicobacter pylori infection in gastroduodenal lesions might be different between the general population and AIDS patients. The aim of the present study was to compare the prevalence of H. pylori and cytomegalovirus (CMV) infection in AIDS patients and HIV-negative controls. The impact of CD4 lymphocyte counts on H. pylori and CMV infection in the same subjects was also assessed.


METHODS
One hundred and fifty-six patients (52 HIV-positive, 104 HIV-negative) with gastrointestinal symptoms were evaluated with upper gastrointestinal endoscopy and biopsy. Comparison of the prevalence of H. pylori and CMV infection was made by dividing AIDS patients into two groups: those with CD4 counts >100/mm3 and those with CD4 counts <100/mm3, and ulcer and non-ulcer patients.


RESULTS
In comparison with HIV-negative controls, AIDS patients had a lower prevalence of H. pylori infection (P < 0.0001) but a higher prevalence of CMV infection (P < 0.0001). Cytomegalovirus infection was frequently found in AIDS patients with CD4 count <100/mm3, in comparison with those with a CD4 count >100/mm3. In AIDS patients, CMV was more frequently detected in subjects with peptic ulcers (P = 0.0125). Conversely, the prevalence of H. pylori infection in AIDS patients was not different between those with and without peptic ulcers.


CONCLUSIONS
The low prevalence of H. pylori infection and peptic ulcer in AIDS patients suggests a different role of H. pylori infection in peptic ulcer or even a different mechanism of peptic ulcerogenesis in HIV-positive subjects. Cytomegalovirus, rather than H. pylori, may be the main causative pathogen of peptic ulcers in AIDS patients.
Chiu
Han-Mo
HM
Departments of Internal Medicine and Pathology, National Taiwan University Hospital, Taipei, Taiwan.
Wu
Ming-Shiang
MS
Hung
Chien-Ching
CC
Shun
Chia-Tung
CT
Lin
Jaw-Town
JT
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D003586:Cytomegalovirus Infections / Q000453:epidemiology*; D016145:Endoscopy, Digestive System; D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000453:epidemiology*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000097:blood / Q000382:microbiology* / Q000473:pathology; D015995:Prevalence; D012189:Retrospective Studies