H. pylori infection is known as a public health problem across the globe. Its prevalence vary geographically; a study showed that the developing countries have much higher infection rates (90.0%) than the developed countries (1.2–12.0%) (26).. Prevalence of H. pylori infections in HIV patients on ART and associated risk factors has not been well documented in different corners of the sub-Saharan Africa, where more than 66.7% of HIV-infected individuals exist, and where, at the same time, the vast majority of the population gets infected with H. pylori during childhood (1, 27).
In the present study, it was found that the prevalence of H. pylori infection in people living with HIV/AIDS on ART was 64.8%. It is similar with a result reported from Ethiopia 64.2% (23); however, various studies in Ethiopia and other countries showed that the overall prevalence of H. pylori infection in adult dyspeptic patients, as found by the different diagnostic methods, varied between 69.0% and 91.0% (28), 57.9% − 69.7% in Iran (29), and 73.1% in Kenya (30).
The prevalence of this study is higher than reports from different parts of the world such as studies conducted in Brazil where H. pylori infection among HIV positive patients ranges from 32.38%(12) to 37,2%, but lower among HIV negative study participants (75.2%)(15); 51.0% in Romania (30), 8/45(17.7%) by serology and 9/45(20.0%) by 13C-urea breath test in Italy (31); 17.3% in Taiwan (16) and 22.1%, China(32) in HIV-infected than in non- infected (63.5% and 44.8%, respectively) patients; 18.2–34.4%, in Serbia depending on the study period, namely the type of applied ART (18);; 51.5% in HIV patients in Ghana, but lower than HIV negative study groups (88.0%) (20); 46.8% in Nigeria (4),; 28/56(50.0%) in HIV positive patients and 31/56 (55.0%) in HIV negative controls in Cameron (33); 22.5% in Uganda (21). A study conducted in Addis Ababa, Ethiopia among dyspeptic and non-dyspeptic HIV patients showed 31.6% H. pylori (34) which is lower than the finding observed in our study.
The H. pylori prevalence observed in the current study in PLWHIV is lower than studies conducted in various areas of the world such as 75.0% among PLWHIV, and 87.0% in HIV negative study participants in Italy (35); 81.0% in Zambia (36); 68 (75.6%) in Nigeria (37); 36/44 (81.8%) among HIV positives and 148/171 (86.5%) in HIV negative dyspeptic patients in Northwest Ethiopia (38). The sex specific prevalence of H. pylori in our study was shown that female study participants accounted 72.3% which is higher than that of male participants. Similarly, a study conducted in Nigeria showed that 47 (33.8%) were women and 18 (13%) were men (4); 372 (75.9%) females in Ghana (20); 41/61 (67.2%) females in Nigeria (37).
This overall disagreement of H. pylori prevalence in different studies might be due to the use of different methods for the diagnosis of H. pylori between the present study and the previous studies where we used the faecal antigen (ImmunoCardSTAT HpSA kit) test method where as many other studies used culture, ImmunoCardSTAT HpSA rapid test kit and /or SD Bioline H. pylori Ag rapid test kit, serological assay for IgG / IgA antibodies, H. pylori ELISA kit, 13C-urea breath test, histology in either in single or in combination. In addition, this variation might be gone with the type of specimens collected and processed where we collected and analyzed stool specimen, but other studies used different specimens such as stool, blood, and biopsies specimens in combination or single type. The sample size included in the study might also have a contribution for such a variation of H. pylori prevalence in PLWHIV in different studies conducted all over the globe. .
Regarding to the factors associated to H pylori infection among HIV positive patients, we did not find statistically significant differences regarding the socio-demographic factors such as sex (p = 0.126), age (p = 0.423), residence (p = 0.276), marital status (p = 0.998), educational level (p = 0.866), and occupation (p = 0.148) with that of H. pylori infections among the PLWHIV. In addition, H. pylori infection was not found to be statistically significantly associated risk factors to personal habits of our study participants such as alcohol (p = 0.331) and coffee (p = 0.338) use, chat chewing, smoking cigarette, use of salty diet and lack of hand washing practice after toilet (p = 0.190). In agreement with this, level of education (p = 0.416), lack of employment (p = 0.673), personal factors like alcohol consumption (p = 0.618) and cigarette smoking were not associated with H. pylori positivity in a study conducted in Addis Ababa, Ethiopia (34). In contrary to this, drinking coffee (p = 0.025) and chat chewing (p = 0.008) were found to be the risk factors associated with H. pylori infections of the patients in a study conducted in Northwest part of Ethiopia (39). Another study done in Northwest Ethiopia before a decade demonstrated that H pylori infection is very high and associated with history of alcohol intake (p < 0.01) and older age (p < 0.01) (38).
It was found that the study participants with ≤ 3 number of family members living in the same house had about 6.0% more vulnerable for H. pylori infection as compared with those who had > 3 family members (p = 0.015), and those who used rivers and bore-holes as their source of drinking and cooking water were about 9.6% protective of H. pylori infections compared to those who used their water sources from protected-pipe lines (p = 0.045). Unlike to this, a study conducted in Northwest Ethiopia showed that the use of unhygienic water supply from rivers and well are contributing risk factors for infections of with H. pylori (p = 0.017) as compared to those who had water from protected pipeline sources (39). Another study conducted in the Uganda revealed that the number of family members living in same house did not show a statistically significant association to the H. pylori infections of the patients (p = 0.93), but lower age was fond to be a contributing factors for H. pylori positivity (21).
The variations observed about risk factors associated with H. pylori infections in different studies are possibly owing to the size of the study participants included, the differences in socio-economic levels, personal habits and variations in individual practices and geographical locations. Moreover, as shown in most epidemiological data, the living standards associated with improved hygiene (toilets, running water, safe drinking water, and hand washing practice within families) are associated with reduction in the infection prevalence. In most of the high standard of living countries, the prevalence is nowadays low and a decreasing trend has been noted(40, 41). It is the reason why the infection rate is especially higher in developing countries, where contaminated water, combined with social hardships and poor sanitary conditions, plays a key role.