Intestinal Colonization with Tropheryma whipplei—Clinical and Immunological Implications for HIV Positive Adults in Ghana

Abstract

Background: Recent studies demonstrated higher prevalence rates of Tropheryma whipplei (T. whipplei) in HIV positive than in HIV negative subjects. However, associations with the immune status in HIV positive participants were conflicting. Methods: For this cross-sectional study, stool samples of 906 HIV positive and 98 HIV negative individuals in Ghana were tested for T. whipplei. Additionally, sociodemographic parameters, clinical symptoms, medical drug intake, and laboratory parameters were assessed. Results: The prevalence of T. whipplei was 5.85% in HIV positive and 2.04% in HIV negative participants. Within the group of HIV positive participants, the prevalence reached 7.18% in patients without co-trimoxazole prophylaxis, 10.26% in subjects with ART intake, and 12.31% in obese participants. Frequencies of clinical symptoms were not found to be higher in HIV positive T. whipplei carriers compared to T. whipplei negative participants. Markers of immune activation were lower in patients colonized with T. whipplei. Multivariate regression models demonstrated an independent relationship of a high CD4+ T cell count, a low HIV-1 viral load, and an obese body weight with the presence of T. whipplei. Conclusions: Among HIV positive individuals, T. whipplei colonization was associated with a better immune status but not with clinical consequences. Our data suggest that the withdrawal of co-trimoxazole chemoprophylaxis among people living with HIV on stable cART regimen may inadvertently increase the propensity towards colonization with T. whipplei.

Doença de whipple associada ao HIV – relato de caso

“…A prevalência da DW foi mais que o dobro em PVHIV, de 5,85% contra 2,08% em pessoas com estado sorológico negativo para HIV. O panorama se fez ainda mais preocupante ao considerar comorbidades associadas, pois a prevalência de DW chegou a 12,31% em PVHIV obesos 5 .…”

“…2 Há suspeitas de que pode ser causada por pré-disposições imunológicas genéticas ou adquiridas, como a síndrome da imunodeficiência humana adquirida (AIDS) que age através da imunossupressão pela baixa contagem de Linfócitos-T CD4+, já que o vírus utiliza da alteração do DNA destas células para se multiplicar e continuar se disseminando 3 . A associação da DW com o HIV ainda carece de literatura, em busca através dos principais portais de acesso a artigos científicos às palavras-chaves "whipple" e "hiv" em conjunto trouxeram apenas cinco resultados relevantes a esse estudo, destes, 4 outros relatos de caso [9][10][11][12] e 1 estudo transversal em Ghana 5 .…”

The Clinical Features and Immunological Signature of Cyclospora cayetanensis Co-Infection among People Living with HIV in Ghana

“…This cross-sectional observational study is part of a work investigating the prevalence of Helicobacter pylori and other gastrointestinal co-infections in HIV-positive and -negative adults and was conducted at the Komfo Anokye Teaching Hospital, a tertiary referral hospital in the Ashanti Region of Ghana [ 12 , 13 , 14 , 15 ]. Between November 2011 and November 2012, consecutive HIV-positive patients presenting to the HIV outpatient department, and HIV-negative blood donors presenting to the blood bank of the hospital, were offered participation in the study.…”

Screening for Schistosoma spp. and Leishmania spp. DNA in Serum of Ghanaian Patients with Acquired Immunodeficiency

“…The study was performed with a group of 1095 HIV-positive Ghanaian patients and a smaller comparison group of 107 HIV-negative Ghanaian blood donors. Residual serum samples that had been taken in the course of the previous studies, as detailed elsewhere [ 67 , 68 , 69 , 70 , 71 ], were available for 1083 individuals (980 HIV positive and 103 HIV negative). Clinical information comprised age, sex, HIV status, and the HIV patients’ immunological situation as expressed by the CD4+ lymphocyte count, the CD4+/CD8+ ratio, and the HIV viral load of the HIV-positive patients from the previous assessments [ 67 , 68 ].…”