Volume 3, Number 24;  January 14, 2005

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Clinical Question(s): 

 Would a young HIV-positive patient with abdominal symptoms be likely to have Crohn's disease?

Readings:

 Link Directly to Fulltext article in Ovid

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Unique Identifier: 9512139

Authors: Pospai D. Rene E. Fiasse R. Farahat K. Beaugery L. Lammens P. Reimund C. Duclos B. Le Quintrec Y. Vandercam B. Mignon M.

Institution: Department of Gastroenterology and Nutrition, Bichat Claude-Bernard University Hospital, Paris, France.

Title: Crohn's disease stable remission after human immunodeficiency virus infection.

Source: Digestive Diseases & Sciences. 43(2):412-9, 1998 Feb.

Abstract: We retrospectively assessed the clinical course in four patients with long-standing Crohn's disease who became infected with human immunodeficiency virus (HIV). The duration of active Crohn's disease was 21, 10, 4, and 4 years in our four patients. They experienced a stable remission of Crohn's disease symptoms after HIV infection. In three patients Crohn's disease was in stable remission for 5, 8, and 8 years after HIV infection and all three died from acquired immunodeficiency syndrome-related disease. One patient was still alive without recurrence of Crohn's disease symptoms 7 years following HIV detection. Our observations of a spontaneous improvement in the clinical course of Crohn's disease after HIV infection, suggests that the integrity of the immune response, especially that of CD4 T cells, plays a major role in the tissue injury mechanism in Crohn's disease.

 Link Directly to Fulltext article in Ovid

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Unique Identifier:8835895

Authors: Yoshida EM. Chan NH. Herrick RA. Amar JN. Sestak PM. Willoughby BC. Whittaker JS.

Institution: Department of Medicine, University of British Columbia, Vancouver, Canada.

Title: Human immunodeficiency virus infection, the acquired immunodeficiency syndrome, and inflammatory bowel disease.

Source: Journal of Clinical Gastroenterology. 23(1):24-8, 1996 Jul.

Abstract: The objective of this study was to determine the effect of human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) on inflammatory bowel disease (IBD). A retrospective survey of the medical records of St. Paul's Hospital and its AIDS-care physicians/gastroenterologists searching for patients with both HIV/AIDS and IBD was conducted. Of 1,839 hospitalized patients (4,459 hospital admissions) from 1989 to 1993, two patients with AIDS/HIV and IBD were found. The physician survey revealed four patients for a total of six patients. Four patients developed de novo IBD--two ulcerative colitis (UC), one Crohn's disease (CrD), and one indeterminate colitis (IC)--after HIV infection. Two patients had UC predating HIV seroconversion. The absolute CD4 count of patients with de novo IBD was 210-700 cells/ml at the time of IBD. The patient with IC maintained quiescent IBD from a CD4 count of 190-30 cells/ml. The other had many relapses before HIV seropositivity. With CD4 count depletion, disease activity improved. IBD medications were discontinued at a CD4 count of 130 cells/ml. Diarrhea returned at a CD4 count of 20 cells/ml; however, sigmoidoscopy was unremarkable, and mucosal biopsy revealed cryptosporidiosis without active UC. No patient had an AIDS-related illness during active IBD. Two patients followed to CD4 counts of < 30 cells/ml suffered AIDS-related infections with quiescent IBD. With a progressive decline in CD4 count, IBD disease activity may improve and remit. The CD4 count at which remission occurs may reflect severe immunodeficiency such that risk for AIDS-related infection is high. Active IBD may occur with lesser degrees of immunodeficiency.

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Unique Identifier:8823573

Authors: Sharpstone DR. Duggal A. Gazzard BG.

Institution: Kobler Centre, Chelsea and Westminster Hospital, London, UK.

Title: Inflammatory bowel disease in individuals seropositive for the human immunodeficiency virus.

Source: European Journal of Gastroenterology & Hepatology. 8(6):575-8, 1996 Jun.

Abstract: OBJECTIVE: CD4 lymphocytes mediate disease expression in both human immunodeficiency virus (HIV) infection and inflammatory bowel disease (IBD). Analysis of the clinical course of IBD in HIV-seropositive individuals may elucidate aspects of the role of CD4 lymphocytes in the pathogenesis of these conditions. DESIGN: A retrospective case series study. PATIENTS: Diagnostic coding for IBD and pharmacy records for 5-aminosalicylic acid compounds and rectal steroid preparations were examined for all HIV-seropositive subjects attending the Chelsea and Westminster Hospitals between January 1988 and December 1993. Eight HIV-seropositive individuals with a confirmed diagnosis of IBD were identified. SETTING: HIV/Genitourinary medicine (GUM) units. MAIN OUTCOME MEASURES: Change in CD4 count. RESULTS: Four subjects with an intact colon had a decline in CD4 count of 85 cells/mm3/year, four patients undergoing colectomy had a subsequent rise of four cells/mm3/year and eight case matched controls had a decline of 47 cells/mm3/year. Acute exacerbations of IBD did not cause a significant change in CD4 count. There were no exacerbations of IBD in patients with a CD4 count below 200 cells/mm3. CONCLUSION: HIV infection may influence the pathogenesis of IBD. A chronically inflamed colon may accelerate CD4 cell depletion which is reversed by colectomy.

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2004 Edition

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