Association of Helicobacter pylori Coinfection With Tuberculosis Disease Severity and Treatment Outcomes

Abstract

Background: Helicobacter pylori (HP) has immunomodulatory properties, but its relationship with tuberculosis (TB) severity and outcomes remains uncertain. We evaluated the association between HP infection and TB severity and explored factors associated with HP coinfection and TB treatment outcomes. Methods: We enrolled adults (≥18years) with drug-sensitive, newly diagnosed, bacteriologically confrmed pulmonary TB from two public clinics in Uganda. HP infection was determined using stool antigen testing. Severe TB was defned as GeneXpert cycle threshold < 16 or smear grade 3þ (microbiological), Bandim TB score ≥8 (clinical), and chest X-ray Timika score >71 (radio logical). Treatment outcomes were determined ≥7months after treatment initiation. Results: Among 200 participants, 67 (33.5%) were HP positive. Severe radiological TB was more frequent among HP positive participants (34.8% vs. 22.1%, p = 0.060). Severe clinical (14.9% vs. 11.3%, p = 0.549) and microbiological TB(40.0% vs. 33.8%, p = 0.856) were also more frequent in HP. HP was not signifcantly associated with severe radiological (adjusted prevalence ratio [aPR] 1.56; 95% CI 0.96–2.53, p = 0.074), clinical (aPR 1.17; 95% CI 0.53–2.60, p = 0.694), or microbiological TB (aPR 1.14; 95% CI 0.80–1.63, p = 0.462). HP coinfection was independently associated with rural residence (aPR 1.61; 95%CI1.04–2.47,p = 0.031),anorexia(aPR1.72;95%CI1.01–2.90,p = 0.045),and lower diastolic blood pressure(aPR 0.98; 95% CI 0.96–1.00, p = 0.013). TB treatment success was similar among those with and without HP (95.5% vs. 95.5%, p =0.180). Conclusion: HP was not signifcantly associated with TB severity or outcomes, though a trend toward greater radiological severity warrants further investigation in larger, prospective studies.