Examination of epidemiological, clinical and pathohistological characteristics of helicobacter pylori infection in HIV infected patients

Pacijenti koji su inficirani virusom humane imunodeficijencije (HIV), tokom svoje bolesti, imaju različite gastrointestinalne simptome koji uključuju i dispepsiju. Gastrointestinalni simptomi mogu biti posledica dejstva samog HIV-a, različitih oportunističkih i ne-oportunističkih infekcija uključujući i infekciju sa Helicobacter pylori (H. pylori), kao i negativne efekte visoko aktivne antiretrovirusne terapije (HAART). H. pylori ima glavnu ulogu u patogenezi hroničnog gastritisa, peptičke ulkusne bolesti, karcinoma želuca, MALT limfoma i nekoliko ekstra-gastričnih manifestacija. Ona je jedan od najznačajnijih bakterijskih patogena u opštoj populaciji, a prevalencija ove infekcije se procenjuje na više od 50% u svetskoj populaciji. Faktori rizika i putevi prenosa ove infekcije su još uvek nedovoljno jasni. Prevalencija H. pylori infekcije kod ljudi koji su inficirani HIV-om (PLHIV) varira od 10 do 76%, zavisno od vremenskog perioda kada je rađeno istraživanje, geografske lokalizacije i populacije. Studije koje su rađene ranije, prijavile su nižu prevalenciju ove koinfekcije kod PLHIV u poređenju sa HIV negativnim kontrolama, suprotno novijim podacima, u modernoj - sadašnjoj HAART eri, u kojoj se prevalenija H. pylori infekcije kod PLHIV približava prevalenciji koja postoji u opštoj populaciji. Cilj: Procena učestalosti H. pylori infekcije u populaciji HIV-om inficiranih u odnosu na kontrolnu grupu sa H. pylori monoinfekcijom, povezanosti imunskog statusa sa dispeptičnim simptomima, endoskopskim i patohistološkim nalazima sluznica želuca i dvanaestopalačnog creva, zatim procena uticaja antiretrovirusne terapije (ART) na učestalost H. pylori koinfekcije i patohistološki nalaz sluznice želuca i ispitivanje faktora rizika za H. pylori infekciju kod inficiranih HIV-om u odnosu na kontrolnu grupu. Materijali i metode: Istraživanje je sprovedeno kao studija slučajeva i kontrola u periodu od 01.01.1993. godine do 31.12.2015. godine u Beogradskoj Klinici za infektivne i tropske bolesti Kliničkog centra Srbije...People living with HIV infection (PLHIV), during their lifetime of illness, suffer from a variety of gastrointestinal (GI) symptoms, including dyspepsia. GI symptoms may occur due to HIV itself, adverse effects of highly active antiretroviral therapy (HAART), or due to a variety of opportunistic and non – opportunistic infections. H. pylori has a key role in pathogenesis of chronic gastritis, peptic ulcer disease, gastric cancer, MALT lymphoma and a few extra - gastric manifestations. It’s one of the most important bacterial pathogens in the general population worldwide, with the estimated prevalence of more than 50%. The risk factors and transmission pathways for this infection have not yet been fully clarified. The prevalence of H. pylori infection in PLHIV varies between 10 and 76%, depending on the period in which different research was conducted, geographical position and population. Research that was done earlier reported lower prevalence of H. pylori and HIV co-infection compared to HIV negative control groups, contrary to newer data in modern HAART era, in which the prevalence of H. pylori infection in PLHIV approaches the prevalence in general population. Goal: Estimating the frequency of H. pylori co-infection in PLHIV compared to control group, assessing the correlation between immune status and dyspeptic symptoms, endoscopic and pathohistological findings of ventricular and duodenal mucous membranes, estimating effects of HAART on the frequency of H. pylori and HIV co-infection and pathohistological findings of ventricular mucous membrane and revealing the risk factors for H. pylori and HIV co-infection in comparison to the control group. Methods: This case – control study was conducted for the period between 1st January 1993 and 31st December 2015 at University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade. The study included all the patients who were, for the aforecited period of time, due to dyspeptic symptoms, subjected to esophagogastroduodenoscopy (EGDS) with gastric and duodenal tissue biopsy and histological examination of sampled material..

Varicella complications: Is it time to consider a routine varicella vaccination?

Background/Aim. Varicella is a common and benign disease of childhood. Complications are rare, but in some patients, even without risk factors, severe, life threatening complications could be seen. The aim of this study was to establish the type and frequency of varicella complications among hospitalized patients over an 8-year period. Methods. This retrospective analysis included medical charts of the patients hospitalized in the Infectious Disease Clinic, Belgrade, Serbia, from 2001-2008 (4.85% of all registered patients with varicella in Belgrade, 2001-2008). Among hospitalised patients dermografic characteristics were analyzed: hospitalisation lenght, presence and type of complications, presence of immunocompromising conditions and outcome of the disease. The diagnosis of varicella was made on clinical grounds, and in persons > 40 years, with negative epidemiological data of contacts, serological confirmation (ELISA VZV IgM/IgG BioRad®) and avidity of IgG antibodies were done to exclude the possibility of disseminated herpes zoster. Results. A total of 474 patient were hospitalized over an 8-year period. The age of patients was from 5 months to 75 years (mean 22.4 ± 16.1, median 23.5 years). The majority of patients were adults (n = 279; 58.9%) and 195 (41.1%) patients were ≤ 15 years old. Complications were found in 321/474 (67.7%) patients. The registered complications were: varicella pneumonia (n = 198; 41.38%), bacterial skin infections (n = 40; 8.4%), cerebelitis (n = 28; 5.9%), bacterial respiratory infection (n = 21; 4.4%), viral meningitis (n = 10; 2.31%), encephalitis (n = 9; 1.9%), thrombocytopenia (n = 2; 0.4%); 11 (2.3%) patients had more than one complication, among them were sepsis, myopericarditis and retinal hemorrhages. When complications were analyzed according to the age, there were no statistical significance, but when type of complication was analyzed statistical significance was found (p < 0.05). In adults, pneumonia was the most common complication: 173/279 (62%), followed by skin infections (2.9%), bacterial respiratory infections (2,2%), and more than one complication (2.3%). Pneumonia was more common in adults than in children (7 : 1). In children skin infections were the most common complications (16.4%), followed by cerebelitis (13.3%), viral pneumonia (12.8%), bacterial respiratory infections (7.7%), encephalitis (3.6%), and more than one complication (4.1%). Neuroinfections were more common in children than in adults (6:1), as well as bacterial skin infections (4 : 1). Two patients died (0,4%). Conclusion. There was no difference in the incidence of varicella complication in children and adults, but the type of complication differed. In children the most common complications were skin and neurological infections, while in adults it was varicella pneumonia. These data provide a baseline for estimating the burden of varicella in Belgrade and support the inclusion of varicella vaccine in childhood immunisation program in Serbia

The increasing prevalence of HIV/Helicobacter pylori co-infection over time, along with the evolution of antiretroviral therapy (ART)

Helicobacter pylori (H. pylori) is one of the most common human bacterial infections with prevalence rates between 10–80% depending upon geographical location, age and socioeconomic status. H. pylori is commonly found in patients complaining of dyspepsia and is a common cause of gastritis. During the course of their infection, people living with HIV (PLHIV) often have a variety of gastrointestinal symptoms including dyspepsia and while previous studies have reported HIV and H. pylori co-infection, there has been little data clarifying the factors influencing this. The aim of this case-control study was to document the prevalence of H. pylori co-infection within the HIV community as well as to describe endoscopic findings, gastritis topography and histology, along with patient demographic characteristics across three different periods of time during which antiretroviral therapy (ART) has evolved, from pre- highly active antiretroviral therapy (HAART) to early and modern HAART eras. These data were compared to well-matched HIV negative controls. Two hundred and twelve PLHIV were compared with 1,617 controls who underwent their first esophagogastroduodenoscopy (EGD) to investigate dyspepsia. The prevalence of H. pylori co-infection among PLHIV was significantly higher in the early (30.2%) and modern HAART period (34.4%) compared with those with coinfection from the pre-HAART period (18.2%). The higher rates seen in patients from the HAART eras were similar to those observed among HIV negative controls (38.5%). This prevalence increase among co-infected patients was in contrast to the fall in prevalence observed among controls, from 60.7% in the early period to 52.9% in the second observed period. The three PLHIV co-infected subgroups differed regarding gastritis topography, morphology and pathology. This study suggests that ART has an important impact on the endoscopic and histological features of gastritis among HIV/H. pylori co-infected individuals, raising the possibility that H. pylori-induced gastritis could be an immune restoration disease