HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION, THE ACQUIRED-IMMUNODEFICIENCY-SYNDROME, AND INFLAMMATORY BOWEL-DISEASE

The objective of this study was to determine the effect of human immun odeficiency virus (HIV) infection/acquired immunodeficiency syndrome ( AIDS) on inflammatory bowel disease (IBD). A retrospective survey of t he 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 admissi ons) from 1989 to 1993, two patients with AIDS/HIV and IBD were found. The physician survey revealed four patients for a total of six patien ts. Four patients developed de novo IBD-two ulcerative colitis (UC), o ne Crohn's disease (CrD), and one indeterminate colitis CIC)after HIV infection. Two patients had UC predating HIV seroconversion. The absol ute 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. One of the two patients with UC pre dating H IV seropositivity had UC relapses at CD4 counts of 530-440 cells/ml. T he other had many relapses before HIV seropositivity. With CD4 count d epletion, disease activity improved. IBD medications were discontinued at a CD4 count of 130 cells/ml. Diarrhea returned at a CD4 count of 2 0 cells/ml; however, sigmoidoscopy was unremarkable, and mucosal biops y revealed cryptosporidiosis without active UC. No patient had an AIDS -related illness during active IBD. Two patients followed to CD4 count s of <30 cells/ml suffered AIDS-related infections with quiescent IBD. With a progressive decline in CD4 count, IBD disease activity may imp rove and remit. The CD4 count at which remission occurs may reflect se vere immunodeficiency such that risk for AIDS-related infection is hig h. Active IBD may occur with lesser degrees of immunodeficiency.