Department of Gastroenterology, University Hospital Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium.
Department of Hospital Hygiene, University Hospital Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium.
HIV Med. 2021 Aug;22(7):547-556. doi: 10.1111/hiv.13083. Epub 2021 Mar 25.
Helicobacter pylori is a worldwide infection, but little is known about the efficacy of treatment for H. pylori infection in HIV-positive patients. The goal of this work was to evaluate outcomes after first-line H. pylori treatment and identify risk factors for failure in HIV-positive patients.
This registry study of unmatched H. pylori-infected HIV-positive patients and HIV-negative obese pre-bariatric surgery controls was performed in a tertiary university hospital. Cases were enrolled from 2006 to 2017, controls from 2007 to 2014, and both received standard of care. An additional 'optimal' subgroup of cases was enrolled prospectively from 2017 to 2019 which was treated only on the basis of antibiogram, drug interaction search and additional support by one referent physician. Helicobacter pylori eradication failure rates were compared according to clinical, microbiological and pathological parameters and treatment.
We analysed 258 HIV-positive patients and 204 HIV-negative control patients. Helicobacter pylori eradication failure rates were markedly greater in cases (24.1%) than in controls (8.8%). The proportions of levofloxacin and metronidazole resistance were greater in cases than in controls (P < 0.05). Among cases treated with H. pylori triple therapy (S3T), the 'optimal' subgroup experienced a 9.5% failure rate vs. 28.6% with other strategies (P = 0.01). Risk factors for failure were H. pylori treatment strategy, exposure to antiretroviral treatment, and alcohol status. Overall, positive HIV status was a risk factor for S3T eradication failure.
Patients co-infected with H. pylori and HIV frequently failed to eradicate H. pylori and this was related to treatment strategy, antiretroviral exposure and lifestyle.
幽门螺杆菌是一种全球性感染，但对于 HIV 阳性患者的幽门螺杆菌感染治疗效果知之甚少。本研究旨在评估 HIV 阳性患者一线幽门螺杆菌治疗后的结局，并确定治疗失败的危险因素。
这是一项在一家三级大学医院进行的未匹配的幽门螺杆菌感染 HIV 阳性患者和 HIV 阴性肥胖拟接受减重手术对照者的登记研究。病例于 2006 年至 2017 年期间入选，对照者于 2007 年至 2014 年期间入选，均接受标准治疗。2017 年至 2019 年期间前瞻性纳入了一个额外的“最佳”病例亚组，仅根据药敏试验、药物相互作用搜索和一位参考医生的额外支持进行治疗。根据临床、微生物学和病理学参数以及治疗方法比较了幽门螺杆菌根除失败率。
我们分析了 258 例 HIV 阳性患者和 204 例 HIV 阴性对照者。病例组（24.1%）的幽门螺杆菌根除失败率明显高于对照组（8.8%）。病例组左氧氟沙星和甲硝唑耐药率高于对照组（P<0.05）。在接受三联疗法（S3T）治疗的病例中，“最佳”亚组的失败率为 9.5%，而其他策略的失败率为 28.6%（P=0.01）。失败的危险因素是幽门螺杆菌治疗策略、抗逆转录病毒治疗的暴露以及酒精状态。总的来说，HIV 阳性状态是 S3T 根除失败的危险因素。
合并感染幽门螺杆菌和 HIV 的患者常不能根除幽门螺杆菌，这与治疗策略、抗逆转录病毒暴露和生活方式有关。
