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Background: Gut microorganisms are associated with atherosclerosis and related cardiovascular disease. Helicobacter pylori (H. pylori) infection is associated with dyslipidemia and inflammation contributing to the progression of atherosclerosis., Objective: Several studies have reported reduced HDL-C levels in H. pylori infected patients, but HDL cholesterol efflux capacity (CEC) as the most important function of HDL has not been evaluated yet., Methods: This cross-sectional study was conducted with 44 biopsy confirmed H. pylori patients and 43 controls. ABCA1-mediated, non-ABCA1 and total CEC were measured in ApoB-depleted serum and levels of ApoA-I, ApoB and hsCRP were estimated using ELISA technique., Results: Total and ABCA1 mediated-CEC were reduced in patients compared to controls, independent of age, sex, body mass index and HDL-C (p < 0.001), while non-ABCA1 CEC indicated no significant change between the groups. In addition, patients showed lower serum levels of ApoA-I but increased levels of hsCRP when compared to controls. Total CEC and ABCA1-mediated CEC positively correlated with ApoA-I and HDL-C, furthermore, ABCA1-mediated CEC as well as ApoA-I inversely correlated with hsCRP., Conclusion: The results of the present study indicate reduced CECs in H. pylori infected patients, especially ABCA1-mediated CEC which is associated with decreased ApoA-I and increased inflammation., (Copyright © 2020 National Lipid Association. Published by Elsevier Inc. All rights reserved.)