Inflammatory bowel disease in individuals seropositive for the human immunodeficiency virus.
OBJECTIVE
CD4 lymphocytes mediate disease expression in both human immunodeficiency virus (HIV) infection and inflammatory bowel disease (IBD). Analysis of the clinical course of IBD in HIV-seropositive individuals may elucidate aspects of the role of CD4 lymphocytes in the pathogenesis of these conditions.


METHODS
A retrospective case series study.


METHODS
Diagnostic coding for IBD and pharmacy records for 5-aminosalicylic acid compounds and rectal steroid preparations were examined for all HIV-seropositive subjects attending the Chelsea and Westminster Hospitals between January 1988 and December 1993. Eight HIV-seropositive individuals with a confirmed diagnosis of IBD were identified.


METHODS
HIV/Genitourinary medicine (GUM) units.


METHODS
Change in CD4 count.


RESULTS
Four subjects with an intact colon had a decline in CD4 count of 85 cells/mm3/year, four patients undergoing colectomy had a subsequent rise of four cells/mm3/year and eight case matched controls had a decline of 47 cells/mm3/year. Acute exacerbations of IBD did not cause a significant change in CD4 count. There were no exacerbations of IBD in patients with a CD4 count below 200 cells/mm3.


CONCLUSIONS
HIV infection may influence the pathogenesis of IBD. A chronically inflamed colon may accelerate CD4 cell depletion which is reversed by colectomy.
Sharpstone
D R
DR
Kobler Centre, Chelsea and Westminster Hospital, London, UK.
Duggal
A
A
Gazzard
B G
BG
D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D016022:Case-Control Studies; D006678:HIV / Q000276:immunology*; D006679:HIV Seropositivity / Q000150:complications / Q000276:immunology; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000453:epidemiology* / Q000276:immunology / Q000601:surgery; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies