title: HIV-Helicobacter pylori Co-Infection: Antibiotic Resistance, Prevalence, and Risk Factors.
abstract: BACKGROUND
  Patients infected with human immunodeficiency virus (HIV) are living longer due to the availability of more potent treatments. However, prescription of antibiotics to treat or prevent infections in these patients may increase the likelihood of co-infection with antibiotic-resistant species.
  
  
  OBJECTIVE
  To compare antimicrobial susceptibility of Helicobacter pylori (H. pylori) in HIV-positive and HIV-negative patients and assess risk-factors for resistance.
  
  
  METHODS
  We prospectively collected data from consecutive HIV-positive and HIV-negative patients undergoing upper gastrointestinal endoscopy. Patients with H. pylori-positive gastric biopsies who had never received H. pylori treatment were included.
  
  
  RESULTS
  Of the 353 patients included, 93 were HIV-positive and 260 HIV-negative. Among the HIV-positive patients, 56 (60%) had been infected for <10 years, the median CD4+ count was 493 cells/μl and median viral load was 61 copies/mL; 66 (71%) were receiving antiretroviral therapy. HIV-positive patients were more often male (p = 0.009), had a lower body mass index (p<0.0001), and had less frequently received antibiotics during the 12-months prior to the endoscopy (p<0.0001) than HIV-negative patients. HIV-positive patients were more likely to have H. pylori resistant to levofloxacin (p = 0.0004), metronidazole (p = 0.01), or multiple antibiotics (p = 0.006). HIV-positive Black Africans were more likely to have resistant strains than were HIV-negative Black Africans (p = 0.04). Ethnicity and HIV status were independent risk factors for H. pylori resistance in all patients and acquired immune deficiency syndrome (AIDS) and sex were risk factors in HIV-positive patients.
  
  
  CONCLUSIONS
  There was a higher prevalence of primary H. pylori-resistant strains in HIV-positive than in HIV-negative patients. AIDS and sex were predictors of H. pylori resistance in HIV-positive patients.
authors.affiliation: Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Marcel
authors.initials: M
authors.lastname: Nkuize
authors.affiliation: Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Stéphane
authors.initials: S
authors.lastname: De Wit
authors.affiliation: Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Vinciane
authors.initials: V
authors.lastname: Muls
authors.affiliation: Division of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Delforge
authors.affiliation: Department of Microbiology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Véronique Y
authors.initials: VY
authors.lastname: Miendje Deyi
authors.affiliation: Department of Digestive Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Guy B
authors.initials: GB
authors.lastname: Cadière
authors.affiliation: Department of Gastroenterology and Hepatology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Buset
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D001530:Belgium / Q000453:epidemiology; D060085:Coinfection / Q000453:epidemiology*; D005260:Female; D015497:HIV-1; D016481:Helicobacter Infections / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors