Course of inflammatory bowel disease in patients infected with human immunodeficiency virus.
BACKGROUND
Human immunodeficiency virus (HIV) infection depletes CD4+ lymphocytes, which may benefit patients with inflammatory bowel disease (IBD). The aim was to compare the course of IBD in HIV patients with a matched group of IBD seronegative patients.


METHODS
A total of 20 IBD (14 Crohn's disease, 6 ulcerative colitis) HIV infected patients and 40 matched control seronegative IBD patients (2 controls per case) were compared regarding relapse of their disease. The CD4+ count was followed every 6 months and a value of < or =500 cells/microL was used to define patients with immunosuppression. Relapse rates per year of follow-up were compared among the 2 groups and survival curves for cumulative remission rates were compared with a log-rank test. Multivariate analysis was used to discriminate among the impact of different variables on the risk of IBD relapse.


RESULTS
The median duration of follow-up was 8.4 years (range 0.6-18 years). The mean relapse rate for the HIV+IBD group was 0.016/year of follow-up as compared to 0.053/year of follow-up for the IBD-matched control group (P = 0.032). Regarding the HIV-positive/IBD group, 14 patients were immunosuppressed at any given time during the follow-up period. None of these patients experienced an IBD relapse, whereas 3 out of the 6 without immunosuppression relapsed (P = 0.017). According to the multivariate analysis, HIV status was the only risk factor independently associated with a lower probability of IBD relapse.


CONCLUSIONS
HIV infection reduces the relapse rates in IBD patients and this may be attributed to the lower CD4+ counts seen in these patients.
Viazis
Nikos
N
2nd Department of Gastroenterology, Evangelismos General Hospital, Athens, Greece. Nikos.Viazis@gmail.com
Vlachogiannakos
John
J
Georgiou
Ourania
O
Rodias
Miltiadis
M
Georgiadis
Dimosthenis
D
Papastamopoulos
Vassilios
V
Baraboutis
Ioannis G
IG
Karamanolis
Dimitrios G
DG
Skoutelis
Athanasios
A
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001379:Azathioprine / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000276:immunology* / Q000401:mortality; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D019804:Mesalamine; D001379:Azathioprine