Changes in circulating levels of HIV, CD4, and tissue expression of HIV ina patient with recent-onset ulcerative colitis treated by surgery - Case report

Objective: To determine CD4(+) T-cell count and circulating and tissue leve ls of HIV before and after surgery in a patient with recent-onset ulcerativ e colitis. Study Design/Methods: CD4 lymphocytes and circulating and tissue HIV RNA le vels were measured in an HIV-infected patient with ulcerative colitis befor e and after proctocolectomy. Results: Approximately 3 weeks prior to surgery for ulcerative colitis that was unresponsive to corticosteroids, the patient's CD4 count was 930 cells /mm(3) and fell to 313 cells/mm(3) within 10 days; the viral burden was sim ilar to 80,000 RNA copies/mL. Tissue macrophages and lymphocytes in biopsy and resection specimens were shown to express high levels of PW RNA by in s itu hybridization. Five days postoperatively, the patient became asymptomat ic and was discharged on tapering prednisone without antiretroviral agents. After surgery, the patient's CD4 count progressively rose, while viral RNA levels precipitously dropped. At 3, 6, and 15 weeks postoperatively, CD4 a nd viral RNA counts were 622 cells/mm(3) and 31,300 RNA copies/mL, 843 cell s/mm(3) and 11,400 RNA copies/mL, and 747 cells/mm(3) and 1500 RNA copies/m L, respectively. Conclusions: Circulating levels of HIV and CD4(+) cells, as well as tissue expression of HIV, apparently can be influenced by localized inflammatory p rocesses such as those occurring in inflammatory bowel disease.