Kenya Association of Physicians Conference 16 TH Annual Scientific - - PowerPoint PPT Presentation

Kenya Association of Physicians Conference

16TH Annual Scientific Conference presentation BY: Dr. Kalya Stephen

Date:24TH MARCH 2012,Enashipai Resort and Spa- Naivasha

Title

Seroprevalence of Helicobacter pylori

antibodies in HIV infected patients presenting at Moi Teaching and Referral Hospital- Eldoret, Kenya.

Introduction

 Helicobacter pylori is a gram negative,

microaerophilic, curved bacillus.

 Implicated in the pathogenesis gastritis,

gastric and duodenal ulceration, gastric cancer1

1.Werneck-Silva AL, Prado IB. Helicobacter pylori status, endoscopic findings, and serology in HIV-1-positive patients. Dig Dis Sci. 1995

Background

Prevalence:

 In developing countries: up to 70% have

evidence of H. pylori infection by age of

• 50. 1,2,

 case-control study (KNH 2002) H. pylori prevalence was 73.1% HIV

positive and 84.6% in HIV negatives2

2 Ali Mohamed F, Lule GN, Nyong'o A, Bwayo J, Rana FS. Prevalence of Helicobacter pylori and endoscopic findings in HIV seropositive patients with upper gastrointestinal tract symptoms at Kenyatta National Hospital, Nairobi. East Afr Med J. 2002 May; 79(5):226-31.

H.pylori and HIV

In China (2007)

 among 151 patients:  151 patients (122 HIV-positive and 29

HIV-negative) with GI symptoms had OGD and biopsy 6.

 The prevalence of H pylori in HIV-

positive patients (22.1%) and HIV- negative controls (44.8%; P < 0.05)

6 Chiu HM, Wu MS, Hung CC, Shun CT, Lin JT. A low prevalence of H pylori and endoscopic findings in HIV-positive Chinese patients with gastrointestinal symptoms. World J Gastroenterol. 2007 Nov 7; 13(41):5492-6.

H.pylori and HIV However, in 1995 (Denmark)

 among 102 HIV patients  the seroprevalence of H. pylori was not

significantly different (19% vs. 25%) between cases and controls8.

• 8 .Skwara P, Mach T, T
• maszewska R, Sobczyk-Krupiarz I, Cieśla A Review

Helicobacter pylori infection as a cause of gastritis, duodenal ulcer, gastric cancer and nonulcer dyspepsia: a systematic overview. CMAJ. 1994 Jan 15; 150(2):177-85.

Objectives

 Main objective:  To determine the seroprevalence of

H.pylori antibodies in HIV infected patients presenting at MTRH Eldoret- Kenya

 Secondary objective:  To determine the association between

• H. pylori infection and degree of

immunosuppression in HIV infected patients

Methodology

 Study design:  This was a cross sectional study  Study population:  Was composed of HIV infected patients

attending MTRH AMPATH clinic.

 Study site:  The study was conducted at MTRH

AMPATH clinic caring for over 5000 HIV infected patients of the 125,000 enrolled

Laboratory methods/Data Management

 Serodiagnosis using rapid ELISA for IgG/IgA

 STATA

V.10 for analysis

Eligibility criteria

 Inclusion Criteria:

 18 years and above  HIV positive

Results

Table1: Characteristics of 209 participants

Characteristic N (%)

Female 145 (69.4%) Mean age(yrs) 37.9 (SD 7.9) Housewives 43 (20.6%) Teachers 17 (8.1%) Businessmen(women) 35 (16.7%%) Farmers 24 (11.5%) Median CD4 count 356.5 (212.8- 538.5) Characteristic N (%)

Mean weight(kg) ) 4 . 11 (SD + 2 . 62 With dyspepsia 147 (70%) Take alcohol 32 (15%)

Smoke 13 (6%) On antiretroviral therapy 124 (59.3 %) On PCP prophylaxis 98 (47%) On TB prophylaxis 2 (1%) On TB treatment 6 (3%)

Fig 1 :Distribution of 147

participants with dyspepsia

Fig 2: WHO staging of the 209 HIV infected patients

Fig 3 :H. Pylori seroprevalence

Table 2: H.pylori serostatus and participant characteristic

Variable H.Pylori test

chi-value p-value

Positive (%) Negative (%) Gender: Male Female 37 (57.8) 78 (53.8) 27 (42.2) 67 (46.2)

0.29 0.652

Take alcohol: Yes No 20 (62.5) 100 (56.6) 12 (37.5) 77 (43.4)

0.703 0.562

Smoke: Yes No 9 (69.2) 112 (57.2) 4 (30.8) 84 (42.8)

0.379 0.562

Regimen line: 1st 2nd 60 (55) 5 (33.3) 49 (45) 10 (66.7)

3.467 0.063

Fig 5: Seroprevalence of H.pylori among

patients with different categories of CD4 count

Table 4: Association between HIV stage, dyspepsia, CD4, ARV and H.pylori

Factor H.pylori serology test

Chi-square/t- value

P-value

Positive Negative HIV stage I II III IV 37 27 40 11 29 21 36 8 0.467 0.926 Dsypepsia 84 63 1.733 0.188 CD4 count(median) 321(197.8, 472) 402(242.5, 568.3) 1.600 0.110 On ARV 64 60 1.433 0.231

Discussion

 The mean age 37.9 years

 consistent with structure of Kenyan

population

 Patients female at 69.4%

 Same as Ethiopian study in which females

accounted for 55% of the participants.25

 The median CD4 count was 356.5

compared to KNH study in 2002 where the median was 671.

Discussion

 The prevalence of H.pylori in this study is

55%

 lower than the KNH and Ethiopian studies

which had a prevalence of 71.3% and 85.6% respectively.1,2,3

 Found no association between H.pylori status

and:

 the CD4 level;  presence of dyspepsia;  ARV use ;  and HIV clinical stage.

Conclusion

 Study finds that :

 the seroprevalence of H. pylori antibodies in

selected HIV infected patients in Western Kenya to be 55% .

 no significant association between the

degree of immunosuppression, ARV type and dyspeptic

 Patients with dyspepsia were found more

likely to have positive H. pylori test.

Recommendation

 We do not recommend routine testing for

H.pylori among HIV infected patients

 HIV infected patients with dyspepsia

should receive a H. pylori test and appropriate treatment

Study Limitation

 Serodiagnosis has a sensitivity of 98% and

specificity of 80% .