Helicobacter pylori in the Era of Highly Active Antiretroviral Therapy (HAART): A Review

Human Immunodeficiency Virus (HIV) infection predisposes to a multitude of opportunistic infections, many of them resulting in gastrointestinal symptoms. There were doubts about the pattern of the incidence of H.pylori in HIV infected patients: one group argues that the immunodeficiency allows the increased replication of the bacteria and in the other hand others argues that there is no inflammation in the stomach for the H.pylori replication. So we aimed to find out the answer for this question, with a review of the literature. We find that the incidence of H.pylori infection is lower among patients with Acquired Immunodeficiency Syndrome (AIDS) compared to matched HIV-infected and -uninfected controls. This event suggests a correlation between the improvement of immunity as a result of more efficient antiviral therapy and the decrease in the frequency of digestive diseases in AIDS, mainly opportunistic pathologies. H.pylori infection and dyspepsia in HIV-infected patients have increased in the High Active Antiretroviral Therapy (HAART) era. H.pylori infection in HIV-infected patients in the post-HAART era has a low prevalence of the bacteria in patients with count of CD4cells < 200/mm3 than in patients with CD4 cells count ≥ 200/mm3.The knowledge of this fact allow us to make different guidelines in dyspepsia in HIV infected patients based on CD4 levels: above 200/ mm3 we can think in opportunistic agents and in patients with CD4 cells count ≥ 200/mm3 we can think in differential diagnosis in dyspepsia like uninfected patients. On the other hand, the managements and the protocols in the presence of dyspepsia in HIV-infected patients or patients in which AIDS are installed resemble the guidelines established for the general population.