HIV related hypochlorhydria does not appear to respond to anti-retroviral therapy in Zambian adults: a case control study.

Abstract

INTRODUCTION:

Human Immunodeficiency Virus (HIV) infection is associated with hypochlorhydria but the mechanism is unknown. The objective of this study was to determine effects of anti-retroviral therapy (ART) on gastric physiology as measured by validated markers.

METHODS:

We studied HIV infected individuals who were either ART-naïve or on treatment with undetectable viral loads. We measured H.pylori IgG antibodies, pepsinogen (PG) 1 and 2 levels and fasting gastrin-17 using Biohit GastroPanel®. Gastric antral biopsies and juice were obtained for histology and pH respectively. Also included were historical data from HIV negative participants (n = 72) in a previous study, for reference.

RESULTS:

We enrolled 84 HIV positive individuals with a median age 42 years (IQR 37-40 years). 55(66%) were female, 32(38%) were ART naïve, and 52(62%) were on ART. Hypochlorhydria (pH>4) was present in 48(57%) of the HIV positive and 18(25%) of the HIV negative individuals (OR 4: 95% CI 1.9-8.5, P<0.001) with no significant effect of ART (OR 0.9: 95% CI 0.3-2.3, P = 0.82). Hypochlorhydria was not associated with the serological detection of corpus atrophy using low PG 1:2 ratio (OR 2.1: 95% CI 0.5-10.2, P = 0.37) or GastroPanel® algorithm, (OR 0.7: 95% CI 0.01-60.1, P = 1.0). ART reduced the frequency of low PG 1:2 ratio (P = 0.001), but not the histological detection in the antrum of atrophy or non-atrophic gastritis.

CONCLUSION:

ART use is associated with reduced serological evidence of corpus atrophy but has no effect on fasting pH, supporting earlier data that suggest that the mechanism of HIV-associated hypochlorhydria is multifactorial.

• Authors: Violet Kayamba, Aaron Shibemba, Kanekwa Zyambo, Douglas Corbett Heimburger, Douglas Morgan, Paul Kelly
• Journal: The Pan African medical journal (Pan Afr Med J) Vol. 31 Pg. 128 ( 2018) ISSN: 1937-8688 [Electronic] Uganda
• PMID: 31037188 (Publication Type: Journal Article)

Chemical References

• Anti-HIV Agents

Topics

• Achlorhydria (drug therapy, etiology)
• Adult
• Anti-HIV Agents (administration & dosage)
• Atrophy (pathology)
• Biopsy (methods)
• Case-Control Studies
• Endoscopy, Gastrointestinal (methods)
• Female
• HIV Infections (complications, drug therapy)
• Humans
• Hydrogen-Ion Concentration
• Male
• Middle Aged
• Treatment Outcome
• Viral Load
• Zambia