HIV - Inflammatory Bowel Syndromes

3/14/2005

Question: What evidence exists for inflammatory bowel syndromes in HIV?

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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:8508707

Authors: Kotler DP. Reka S. Clayton F.

Institution: Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York, New York 10025.

Title: Intestinal mucosal inflammation associated with human immunodeficiency virus infection.

Source: Digestive Diseases & Sciences. 38(6):1119-27, 1993 Jun.

Abstract: The role of the human immunodeficiency virus type-1 (HIV) in producing intestinal disease was studied prospectively in 74 HIV-infected individuals with (43) or without (31) the acquired immunodeficiency syndrome (AIDS). Thirty-one subjects had enteric infections; all but one had AIDS. Alteration in bowel habits was the most common symptom and occurred independently of enteric infections. Abnormal histopathology was present in 69% of cases, and the finding was associated with altered bowel habits. An HIV-associated protein, p24, was detected in 71% of biopsies by ELISA assay. Tissue p24 contents varied with disease stage and were highest in HIV-infected individuals without AIDS (Walter Reed classes 3 and 4). Tissue p24 detection was associated with both altered bowel habits and histologic mucosal abnormalities. Tissue contents of the cytokines, tumor necrosis factor-alpha and interleukin-1 beta, were higher in HIV-infected individuals than in controls and their elevations were independent of enteric infection. We conclude that HIV reactivation in the intestinal mucosa may be associated with an inflammatory bowel syndrome in the absence of other enteric pathogens. CAS Registry/EC Number/Name of Substance 0 (Cytokines). 0 (HIV Core Protein p24).

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Unique Identifier:2836142

Authors: Rene E. Marche C. Chevalier T. Rouzioux C. Regnier B. Saimot AG. Negesse Y. Matheron S. Leport C. Wolff B. et al.

Institution: Department of Gastroenterology, Hopital Bichat, Paris, France.

Title: Cytomegalovirus colitis in patients with acquired immunodeficiency syndrome.

Source: Digestive Diseases & Sciences. 33(6):741-50, 1988 Jun.

Abstract: Twenty-four AIDS patients, who underwent gastrointestinal evaluation, died from their disease and were autopsied. Seven had Cytomegalovirus colitis (group I) and 17 did not (group II). Clinical manifestations, digestive lesions, and infections were compared in the two groups. Chronic watery diarrhea was present in all the patients with colitis but was also present in 65% of the patients without colitis. Hematochezia was present only in the group with colitis (one of seven patients) but appeared late in the diarrheal course, due to necrotizing colitis. No other difference were noted between the two groups (mean duration of diarrhea, frequency and nature of the other infections). As for group I specifically, colonic ulcerations due to Cytomegalovirus were present in all the patients, varying from punctate and superficial erosions to deep ulcerations, with granular and friable intervening mucosa. Severe colonic lesions appeared during the course of Cytomegalovirus colitis in two patients who developed lethal necrotizing colitis. Finally, the clinical and pathologic features of these seven cases were compared to other reports of Cytomegalovirus infection of the colon.

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