INFLAMMATORY BOWEL-DISEASE IN INDIVIDUALS SEROPOSITIVE FOR THE HUMAN-IMMUNODEFICIENCY-VIRUS

Objective: CD4 lymphocytes mediate disease expression in both human im munodeficiency virus (HIV) infection and inflammatory bowel disease (I BD). Analysis of the clinical course of IBD in HIV-seropositive indivi duals may elucidate aspects of the role of CD4 lymphocytes in the path ogenesis of these conditions. Design: A retrospective case series stud y. Patients: Diagnostic coding for IBD and pharmacy records for 5-amin osalicylic acid compounds and rectal steroid preparations were examine d for all HIV-seropositive subjects attending the Chelsea and Westmins ter Hospitals between January 1988 and December 1993. Eight HIV-seropo sitive 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/mm(3)/year, four patients undergoi ng colectomy had a subsequent rise of four cells/mm(3)/year and eight case matched controls had a decline of 47 cells/mm(3)/year. Acute exac erbations of IBD did not cause a significant change in CD4 count. Ther e were no exacerbations of IBD in patients with a CD4 count below 200 cells/mm(3). Conclusion: HIV infection may influence the pathogenesis of IBD. A chronically inflamed colon may accelerate CD4 cell depletion which is reversed by colectomy.