Clinical Immunology, Allergy and AIDS Center, Kaplan Medical Center, Rehovot, Israel.
Int J Infect Dis. 2010 Apr;14(4):e322-7. doi: 10.1016/j.ijid.2009.03.036. Epub 2009 Aug 21.
A significant number of HIV-1 patients experience poor immune reconstitution despite long-term viral suppression with highly active antiretroviral therapy (immunological non-responders). The aims of the present study were to determine whether eradication of Helicobacter pylori could facilitate a better immune reconstitution in these patients.
Forty-nine immunological non-responder HIV-1 patients were evaluated by (13)C-urea breath test (UBT) for the presence of active H. pylori infection. They were all asymptomatic. The UBT was positive in 26 (53%) of them. Eleven patients (group 1) were treated with a combination of omeprazole 20mg bid, amoxicillin 1g bid and clarithromycin 500mg bid for 14 consecutive days. Eight weeks later, successful eradication was proven by a repeat negative UBT in all 11 patients. The remaining 15 (group 2) refused the H. pylori eradication treatment. All 26 patients were followed for 24 months and evaluated for blood CD4 and CD8 cell counts and percentages and for plasma HIV-1 viral load.
At the time of H. pylori diagnosis and eradication (baseline), CD4 and CD8 cell counts were similar in both study groups. All 11 H. pylori eradicated patients (group 1) had a significant increase in CD4 cell count starting 3 months and peaking 12-18 months after H. pylori eradication. Thereafter, CD4 levels gradually declined. Nevertheless, 24 months after triple therapy it was significantly higher than prior to H. pylori eradication. Parallel reciprocal changes were observed in CD8 cell counts. There were no significant changes in either CD4 or CD8 cell counts in group 2 patients. None of the patients of group 1 demonstrated virological failure, while four (26.7%) group 2 patients experienced virological failure requiring change of highly active antiretroviral therapy (HAART) regimen.
Triple therapy for H. pylori eradication is associated with a significant, although possibly transient immune reconstitution in HAART-treated HIV-1 patients with viral suppression without immunological response.
尽管高效抗逆转录病毒疗法（HAART）能长期抑制病毒，但仍有相当数量的 HIV-1 患者出现免疫重建不良（免疫无应答者）。本研究旨在确定根除幽门螺杆菌（H. pylori）能否改善这些患者的免疫重建。
对 49 例免疫无应答的 HIV-1 患者进行（13）C-尿素呼气试验（UBT）以确定是否存在活动性 H. pylori 感染。所有患者均无症状。UBT 阳性者 26 例（53%）。11 例患者（组 1）接受奥美拉唑 20mg bid、阿莫西林 1g bid 和克拉霉素 500mg bid 联合治疗 14 天。8 周后，11 例患者的 UBT 均转为阴性，证明根除成功。其余 15 例（组 2）拒绝 H. pylori 根除治疗。所有 26 例患者均随访 24 个月，检测血 CD4 和 CD8 细胞计数和百分比以及血浆 HIV-1 病毒载量。
在诊断和根除 H. pylori 时（基线），两组患者的 CD4 和 CD8 细胞计数相似。11 例 H. pylori 根除患者（组 1）在 H. pylori 根除后 3 个月开始，12-18 个月时 CD4 细胞计数显著增加。此后，CD4 水平逐渐下降。然而，三联疗法后 24 个月，其水平明显高于 H. pylori 根除前。CD8 细胞计数也观察到平行的相互变化。组 2 患者的 CD4 或 CD8 细胞计数无显著变化。组 1 患者均未发生病毒学失败，而组 2 患者中有 4 例（26.7%）发生病毒学失败，需要改变高效抗逆转录病毒治疗（HAART）方案。
三联疗法根除 H. pylori 与 HAART 治疗的 HIV-1 患者病毒抑制但无免疫应答时的显著（尽管可能是短暂的）免疫重建相关。
