Helicobacter pylori‐Associated Gastritis is Rare in AIDS: antibiotic Effect or a Consequence of Immunodeficiency?

Helicobacter pylori is the principal cause of type B histologic gastritis. AIDS is associated with increased susceptibility to Gram‐negative enteric infections. Using a retrospective study design, we have determined the prevalence of H. pylori‐associated histologic gastritis (based on gastric histopathology) in 201 patients with AIDS. These data were compared with H. pylori prevalence rates (based on serology) from healthy HIV‐negative, age‐matched Australian controls (n = 785) and a cohort (n = 137) of HIV‐negative, dyspeptic patients undergoing panendoscopy and antral biopsy, at a community endoscopy center. Twenty‐five of 201 (12.5%) patients with AIDS had histologic gastritis and, of these, six (25%) had H. pylori. The 3% (six of 201) H. pylori prevalence rate in the AIDS patients was significantly less than age‐matched HIV‐negative controls (22%)p= 0.001 and endoscopy center controls (59%)p= 0.009. The explanation for this unexpectedly low prevalence of H. pylori is not possible from these data. It may be a consequence of antimicrobial therapy. Other potential explanations may include specific HIV‐related host factors, including hypochlorhydria or an inadequate mucosal inflammatory response, which may impair successful colonization of H. pylori.