Fray Martin M. Arroyo-Mercado, MD, Michelle Likhtshteyn, MD, Chi Doan Huynh, MD, Tanuj Chokshi, DO, Gurasees S. Chawla, MD, Evan B. Grossman, MD, Miguel Ramirez, MD, Hector Ojeda Martinez, MD
SUNY Downstate Medical Center, Brooklyn, NY
Introduction: Accumulating evidence indicates an association between CD4 count and Ulcerative colitis (UC) flares in patients with Human Immunodeficiency Virus (HIV)[1,4], whereby patients who have low CD4 counts are less likely to experience UC flares compared to those who have normal CD4 counts. While the exact mechanism is unknown, it is hypothesized that an immunosuppressed state allows for the remission of UC; this idea has been deemed the “Remission Hypothesis” .
Case Description/Methods: Objective - To present a case series of 3 patients with concomitant HIV and Ulcerative Colitis (UC) and examine the association between UC flares, CD4 counts and viral load over time.
Methods: Patient records at two urban university-affiliated medical centers were queried for patients with concomitant HIV and UC. ICD 9 and ICD 10 diagnostic codes for HIV and UC were used to identify patients. Inclusion criteria were confirmed UC via endoscopy, outpatient follow up, viral load and CD4 count documentation. CD4 counts and viral loads levels were compared during hospitalizations and outpatient follow-ups.
Results: 7 patients with UC and HIV were identified; 3 of these 7 patients had sufficient data available for further analysis. Our three patients lived with HIV for an average of 10 years. Patient 1 experienced 4 UC flares requiring inpatient hospitalizations while maintaining CD4 counts above 250 cells/µL and undetectable viral loads (Tab.1). Patient 2 had five UC flares with CD4 counts above 250 cells/µL; an undetectable viral load was noted during 4 of the UC flares (Tab.2). Patient 1 had two flares with CD4 counts above 250 cells/µL; the viral load was undetectable during flares (Tab. 3).
Discussion: The remission hypothesis suggests that patients who have concomitant HIV and UC can experience remission of their inflammatory bowel disease as their CD4 count declines . HIV viral load is a more accurate and more important marker of HIV disease progression, and therefore, a relationship between viral load and UC flares need to be further studied. Our patients continued to experience flares despite suppressed viral load, and CD4 counts above 250 cells/µL. This case series is the first study that considers viral load and CD4 counts when considering IBD flares and disease progression. These findings raise the question of whether IBD flares occurs as a consequence of CD4 count above 250 or low viral load. Further studies with larger populations are needed to elucidate the pathophysiology of IBD and HIV coexistence.
Citation: Fray Martin M. Arroyo-Mercado, MD, Michelle Likhtshteyn, MD, Chi Doan Huynh, MD, Tanuj Chokshi, DO, Gurasees S. Chawla, MD, Evan B. Grossman, MD, Miguel Ramirez, MD, Hector Ojeda Martinez, MD. P2365 - CD4 LEVELS AND VIRAL LOAD DURING ULCERATIVE COLITIS FLARES IN PATIENTS WITH HIV: A CASE SERIES. Program No. P2365. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.