IDIOPATHIC COLONIC INFLAMMATION IN AIDS - AN OPEN TRIAL OF PREDNISONE

Objectives: Idiopathic colonic inflammation and ulceration have been d escribed in HIV infection, but only as isolated case reports, We have been treating this condition with a uniform corticosteroid protocol an d now report our results, Methods: We describe the cases of eight pati ents with HIV infection who had diarrhea for more than 4 wk and inflam mation and/or ulceration in the colon at endoscopy, confirmed by biops y? without any invasive pathogens despite extensive evaluation, Each p atient was treated with prednisone, starting at 40 mg/day, then tapere d according to a standardized protocol, Results: The diarrhea complete ly resolved in three patients and partially improved in five, One pati ent had some improvement but was unable to tolerate the prednisone bec ause of a severe exacerbation of anal warts, He responded to subtotal colectomy, After a minimum follow-up of 8 months (mean, 17 months), on ly one patient (complete response to prednisone) was found to have an enteric pathogen, In this patient, cytomegalovirus colitis was diagnos ed 15 months after prednisone was started, Conclusion: Idiopathic colo nic inflammation or ulceration in HIV infection (1) may respond to cor ticosteroid therapy without life-threatening side effects and (2) is o nly rarely followed by the detection of a recognized pathogen, These o bservations suggest that enteric pathogens are not missed by standard techniques.