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Sousa H, Barroso J, Tavares R, Torres J. Managing IBD Patients with Concomitant HIV Infection - a Systematic Review. Curr Gastroenterol Rep 2024; 26:1-8. [PMID: 38180722 DOI: 10.1007/s11894-023-00914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE OF REVIEW Inflammatory Bowel Disease (IBD) is a chronic GI inflammatory condition induced by a dysregulated immune system activation, whereas HIV infection causes depletion of the immune system, inducing immunosuppression. Given the increasing incidence of IBD across the globe, including in developing countries, the co-prevalence of both conditions is expected to increase. Herein, we systematically review the data describing disease course when both pathologies co-exist. RECENT FINDINGS Overall, the co-prevalence of IBD and HIV is around 0.1 to 2%. While IBD does not seem to affect HIV course, the opposite is controversial, as some studies report milder IBD phenotype, with fewer disease relapses especially when CD4 + counts are lower than 200 cells/µL. Despite growing evidence to support the safety of the use of immunosuppressants and biologics in IBD-HIV infected patients, these classes of drugs are used in less than 50% of patients, as compared to non-HIV infected IBD patients. There is a need for more studies on disease course and safety of IBD medications in the setting of IBD.
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Affiliation(s)
- Hugo Sousa
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Barroso
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Raquel Tavares
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Infectious Diseases Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Joana Torres
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
- Gastroenterology Division, Hospital da Luz, Lisbon, Portugal.
- Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal.
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Inflammatory Bowel Disease in Adult HIV-Infected Patients-Is Sexually Transmitted Infections Misdiagnosis Possible? J Clin Med 2022; 11:jcm11185324. [PMID: 36142970 PMCID: PMC9506593 DOI: 10.3390/jcm11185324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background. The aim of our study was to describe 50 cases of inflammatory bowel disease (IBD) and HIV co-existence that are under medical supervision in Warsaw. Methods. This was a retrospective descriptive study. Fifty HIV-infected patients, diagnosed with IBD during the years 2001–2019, were identified. IBD was diagnosed endoscopically and then confirmed by biopsy. All data was obtained from medical records. Results. All studied patients were male with a median age of 33 years old (range 20–58 years). All, except one, were men who have sex with men (MSM). The median CD4 cell count was 482 cells/µL (range 165–1073 cells/µL). Crohn’s disease (CD) was diagnosed in 7 patients (14%), ulcerative colitis (UC) in 41 patients (82%), and 2 patients (4%) had indeterminate colitis. Forty-nine patients (98%) reported a history of unprotected receptive anal intercourse and different sexual transmitted infections (STIs). Only in 10 patients (20%) were one or more IBD relapses observed. Conclusions. We recommend HIV testing for every MSM with IBD suspicion. Moreover, STIs testing should be performed in every IBD patient with colorectal inflammation, using molecular and serological methods. Persons who reported unprotected receptive anal intercourse seem to have the biggest risk of STI-associated proctitis or proctocolitis mimicking IBD.
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Guillo L, Uzzan M, Beaugerie L, Gornet JM, Amiot A, Pelletier AL, Altwegg R, Laharie D, Abitbol V, Filippi J, Goutorbe F, Nachury M, Nancey S, Viennot S, Reenaers C, Amil M, Caillo L, Buisson A, Collins M, Picon L, Vidon M, Benezech A, Rabaud C, Baumann C, Rousseau H, Dubourg G, Serrero M, Peyrin-Biroulet L. Impact of HIV Infection on the Course of Inflammatory Bowel Disease and Drug Safety Profile: A Multicenter GETAID Study. Clin Gastroenterol Hepatol 2022; 20:787-797.e2. [PMID: 33359726 DOI: 10.1016/j.cgh.2020.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), and human immunodeficiency virus (HIV) both impact innate and adaptive immunity in the intestinal mucosa. As it is a rare situation, the intersection between HIV and IBD remains unclear, especially the impact of HIV infection on the course of IBD, and the drug safety profile is unknown. METHODS We conducted a multicenter retrospective cohort study between January 2019 and August 2020. All adult patients with IBD and concomitant HIV infection were included. Each IBD patient with HIV was matched to two HIV-uninfected IBD patients. RESULTS Overall, 195 patients with IBD were included, including 65 HIV-infected patients and 130 without HIV infection. Of the 65 infected patients, 22 (33.8%) required immunosuppressants and 31 (47.7%) biologics. In the HIV-infected group, the need for immunosuppressants (p = 0.034 for CD and p = 0.012 for UC) and biologics (p = 0.004 for CD and p = 0.008 for UC) was significantly lower. The disease course, using a severity composite criterion, was not significantly different between the two groups for CD (hazard ration (HR) = 1.3 [0.7; 2.4], p = 0.45) and UC (HR, 1.1 [0.5; 2.7], p = 0.767). The overall drug safety profile was statistically similar between the two groups. CONCLUSION Although HIV-infected patients receive less treatments, the course of their IBD did not differ than uninfected, suggesting that HIV infection might attenuate IBD. The drug safety profile is reassuring, allowing physician to treat these patients according to current recommendations.
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Affiliation(s)
- Lucas Guillo
- Department of Gastroenterology, University Hospital of Marseille Nord, Aix-Marseille, Marseille University, Marseille, France; French Institute of Health and Medical Research Nutrition-Genetics and Exposure to Environmental Risks U1256, Department of Gastroenterology, University Hospital of Nancy, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Mathieu Uzzan
- IBD Unit, Department of Gastroenterology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Laurent Beaugerie
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Jean-Marc Gornet
- Department of Gastroenterology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélien Amiot
- EC2M3-EA7375, Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, Assistance Publique-Hôpitaux de Paris, University of Paris Est Créteil, Créteil, France
| | - Anne-Laure Pelletier
- Department of Gastroenterology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - David Laharie
- Service d'Hépato-gastroentérologie et oncologie digestive, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Vered Abitbol
- Departement of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Jérôme Filippi
- Department of Gastroenterology, Archet 2 University Hospital, Nice, France
| | - Felix Goutorbe
- Department of Gastroenterology, Hospital of Bayonne, Bayonne, France
| | - Maria Nachury
- U1286 Institute for Translational Research in Inflammation, French Institute of Health and Medical Research, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
| | - Stéphane Nancey
- French Institute of Health and Medical Research U1111-CIRI, Department of Gastroenterology, Lyon-Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Stéphanie Viennot
- Departement of Gastroenterology, University Hospital of Caen, Caen, France
| | - Catherine Reenaers
- Departement of Gastroenterology, University Hospital of Liège, Liège, Belgium
| | - Morgane Amil
- Departement of Gastroenterology, Les Oudairies Hospital, La Roche-sur-Yon, France
| | - Ludovic Caillo
- Department of Gastroenterology, University Hospital of Nîmes, Nîmes, France
| | - Anthony Buisson
- Infection, Inflammation et Interaction Hôtes Pathogènes, French Institute of Health and Medical Research U1071, Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Michael Collins
- Department of Gastroenterology, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Laurence Picon
- Department of Gastroenterology, University Hospital of Tours, Tours, France
| | - Mathias Vidon
- Department of gastroenterology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Alban Benezech
- Departement of Gastroenterology, Henri Duffaut Hospital, Avignon, France
| | - Christian Rabaud
- Department of Infectious Disease, University Hospital of Nancy, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Cédric Baumann
- Methodology, Data Management and Statistic Unit, Délégation à la Recherche Clinique et à l'Innovation, Methodology Promotion Investigation Department, University Hospital of Nancy, Vandœuvre-Lès-Nancy, France
| | - Hélène Rousseau
- Methodology, Data Management and Statistic Unit, Délégation à la Recherche Clinique et à l'Innovation, Methodology Promotion Investigation Department, University Hospital of Nancy, Vandœuvre-Lès-Nancy, France
| | - Grégory Dubourg
- Institut Hospitalo-Universitaire en Maladies Infectieuses de Marseille, Marseille, France; Microbes, Evolution Phylogénie et Infections, Institute de la Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Mélanie Serrero
- Department of Gastroenterology, University Hospital of Marseille Nord, Aix-Marseille, Marseille University, Marseille, France
| | - Laurent Peyrin-Biroulet
- French Institute of Health and Medical Research Nutrition-Genetics and Exposure to Environmental Risks U1256, Department of Gastroenterology, University Hospital of Nancy, University of Lorraine, Vandœuvre-lès-Nancy, France.
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Nakamura Y, Igaki K, Uga K, Shibata A, Yamauchi H, Yamasaki M, Tsuchimori N. Pharmacological evaluation of TAK-828F, a novel orally available RORγt inverse agonist, on murine chronic experimental autoimmune encephalomyelitis model. J Neuroimmunol 2019; 335:577016. [DOI: 10.1016/j.jneuroim.2019.577016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 11/30/2022]
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Simultaneous Diagnosis of Acute Crohn's Disease and Endometriosis in a Patient Affects HIV. Case Rep Gastrointest Med 2018; 2018:1509167. [PMID: 29854490 PMCID: PMC5966680 DOI: 10.1155/2018/1509167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/03/2018] [Indexed: 11/18/2022] Open
Abstract
This is the case report of a 45-year-old woman affected by HIV, who was hospitalized for diffuse abdominal pain, constipation, and weight loss present for over one month. A colonoscopy showed the presence of a nontransitable stenosis of the ascending colon. A right hemicolectomy was performed. The histological examination reports CD with outbreaks of endometriosis. CD and the HIV infection may coexist in the same individual and it seems that HIV reduces the relapse rate in IBD patients. CD and intestinal endometriosis can also occur simultaneously. The diagnosis is often only made after surgical resection of the diseased segment. These patients were more likely to have stricturing CD but endometriosis does not seem to impact the natural history of CD.
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Ho TH, Cohen BL, Colombel JF, Mehandru S. Review article: the intersection of mucosal pathophysiology in HIV and inflammatory bowel disease, and its implications for therapy. Aliment Pharmacol Ther 2014; 40:1171-86. [PMID: 25267394 DOI: 10.1111/apt.12976] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/04/2014] [Accepted: 09/10/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The immunopathology of inflammatory bowel diseases (IBD) and HIV in the gastrointestinal (GI) tract can be viewed as ends of a spectrum with IBD being associated with 'immune excess' and HIV with 'immune paucity' within the GI tract. AIM To review the pathophysiology of IBD and HIV as they intersect in the gut immune system. METHODS A search was conducted in PubMed using defined keywords 'IBD, inflammatory bowel disease, Crohn's disease, ulcerative colitis, HIV, innate immunity, mucosal layer, macrophage, cytokine, dendritic cells, adaptive immunity, CD4, T cells, Th1, Th2, natural killer T cells (NKT)'. RESULTS Both the mucosal innate defence and adaptive immunity are profoundly affected by IBD and HIV. The pathophysiology of IBD and HIV with regard to mucosal barrier, macrophages, dendritic cells, NK cells, NKT cells and T-cell subsets is distinct yet closely interwoven. There is limited information on the clinical manifestations of patients who have both IBD and HIV. However, recent studies suggest that the clinical course of IBD may be attenuated by concurrent HIV infection - a premise that is reasonably supported by what is known of their pathophysiology. CONCLUSIONS It is apparent that through specific pathophysiological mechanisms, HIV is capable of attenuating inflammation in IBD. In the absence of experimental models, further clinical studies are necessary to better understand patients with concurrent disease and decipher the clinical and mechanistic relationship between HIV and IBD at mucosal surfaces. Such studies are critical to guide therapeutic decisions in the management of patients with IBD infected with HIV.
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Affiliation(s)
- T H Ho
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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7
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Kamat A, Ancuta P, Blumberg RS, Gabuzda D. Serological markers for inflammatory bowel disease in AIDS patients with evidence of microbial translocation. PLoS One 2010; 5:e15533. [PMID: 21125014 PMCID: PMC2981579 DOI: 10.1371/journal.pone.0015533] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 10/06/2010] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Breakdown of the gut mucosal barrier during chronic HIV infection allows translocation of bacterial products such as lipopolysaccharides (LPS) from the gut into the circulation. Microbial translocation also occurs in inflammatory bowel disease (IBD). IBD serological markers are useful in the diagnosis of IBD and to differentiate between Crohn's disease (CD) and ulcerative colitis (UC). Here, we evaluate detection of IBD serological markers in HIV-infected patients with advanced disease and their relationship to HIV disease markers. METHODS IBD serological markers (ASCA, pANCA, anti-OmpC, and anti-CBir1) were measured by ELISA in plasma from AIDS patients (n = 26) with low CD4 counts (<300 cells/µl) and high plasma LPS levels, and results correlated with clinical data. For meta-analysis, relevant data were abstracted from 20 articles. RESULTS IBD serological markers were detected in approximately 65% of AIDS patients with evidence of microbial translocation. An antibody pattern consistent with IBD was detected in 46%; of these, 75% had a CD-like pattern. Meta-analysis of data from 20 published studies on IBD serological markers in CD, UC, and non-IBD control subjects indicated that IBD serological markers are detected more frequently in AIDS patients than in non-IBD disease controls and healthy controls, but less frequently than in CD patients. There was no association between IBD serological markers and HIV disease markers (plasma viral load and CD4 counts) in the study cohort. CONCLUSIONS IBD serological markers may provide a non-invasive approach to monitor HIV-related inflammatory gut disease. Further studies to investigate their clinical significance in HIV-infected individuals are warranted.
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Affiliation(s)
- Anupa Kamat
- Department of Cancer Immunology and AIDS, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Petronela Ancuta
- Departement de Microbiologie et Immunologie, Centre de Recherche du Centre Hospitalier de l'Universite de Montreal (CRCHUM) Universite de Montreal and INSERM Unit 743, Montreal, Quebec, Canada
| | - Richard S. Blumberg
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dana Gabuzda
- Department of Cancer Immunology and AIDS, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, United States of America
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Viazis N, Vlachogiannakos J, Georgiou O, Rodias M, Georgiadis D, Papastamopoulos V, Baraboutis IG, Karamanolis DG, Skoutelis A. Course of inflammatory bowel disease in patients infected with human immunodeficiency virus. Inflamm Bowel Dis 2010; 16:507-11. [PMID: 19714759 DOI: 10.1002/ibd.21077] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Nikos Viazis
- 2nd Department of Gastroenterology, Evangelismos General Hospital, Athens, Greece.
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Hertogh GD, Aerssens J, Geboes KP, Geboes K. Evidence for the involvement of infectious agents in the pathogenesis of Crohn's disease. World J Gastroenterol 2008; 14:845-52. [PMID: 18240341 PMCID: PMC2687051 DOI: 10.3748/wjg.14.845] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 12/24/2007] [Indexed: 02/06/2023] Open
Abstract
Many advances have been made in the understanding of Crohn's disease (CD) pathogenesis during the last decade. CD is currently seen as a predominantly T-lymphocyte-driven disease characterized by the presence of a complex cocktail of interacting cytokines, chemokines and other mediators produced by a variety of cell types. Prevailing theories of CD pathogenesis suggest that patients' T-lymphocytes are inappropriately activated in the setting of an immune imbalance, which is itself caused by an unfortunate confluence of genetic and environmental factors. The T-cell response then leads to the chronic inflammation characteristic for the disease. Various environmental factors may play a role in the development of CD, but microbes are most consistently implied. This theory is based on epidemiological, clinicopathological, genetic and experimental evidence. Despite the abundance of arguments for the implication of bacteria in the aetiopathogenesis of CD, the precise role of bacteria in this disease still remains elusive. Three not necessarily mutually exclusive theories have been proposed: (1) an unidentified persistent pathogen; (2) an abnormally permeable mucosal barrier leading to excessive bacterial translocation; and (3) a breakdown in the balance between putative "protective" versus "harmful" intestinal bacteria ("dysbiosis"). At present, one cannot exclude with certainty any of these three proposed hypotheses; they may all apply to CD to a certain extent.
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Rodríguez-Torres M, Rodríguez-Orengo JF, Ríos-Bedoya CF, Fernández-Carbia A, Salgado-Mercado R, Marxuach-Cuétara AM. Double-blind pilot study of mesalamine vs. placebo for treatment of chronic diarrhea and nonspecific colitis in immunocompetent HIV patients. Dig Dis Sci 2006; 51:161-7. [PMID: 16416230 DOI: 10.1007/s10620-006-3102-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Accepted: 03/17/2005] [Indexed: 01/27/2023]
Abstract
Chronic diarrhea and colitis are common in patients positive for human immunodeficiency virus (HIV) under highly active antiretroviral treatment (HAART). This prospective double-blind study explores the effect of mesalamine vs. placebo in HIV-positive patients. Thirteen HIV-infected patients with noninfectious chronic diarrhea and > 250 CD4+ cells/mm(3) were randomized to mesalamine (2.4 g/day; n = 9) or placebo (n = 4) for 6 weeks. Colonoscopy was performed at baseline and week 6, and biopsies were obtained to calculate the Biopsy Activity Index (BAI). Diarrhea was assessed at baseline and end of treatment using the Disease Activity Index (DAI). Patients and clinicians completed Patient Global Improvement index (PGI) and Clinical Global Improvement index (CGI) at weeks 2 and 6. Comparisons at week 6 were statistically significant between mesalamine and placebo groups for BAI (P = 0.03), DAI (P = 0.007), PGI (P = 0.008), and CGI (P = 0.008). Furthermore, major improvements were documented in the mesalamine group at week 6 compared to baseline for all variables, whereas the placebo group did not have any. Mesalamine was effective for treatment of chronic diarrhea and moderate nonspecific colitis in HIV patients.
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Matsuzaki K, Hokari R, Kato S, Tsuzuki Y, Tanaka H, Kurihara C, Iwai A, Kawaguchi A, Nagao S, Itoh K, Nagata K, Miura S. Differential expression of CCR5 and CRTH2 on infiltrated cells in colonic mucosa of patients with ulcerative colitis. J Gastroenterol Hepatol 2003; 18:1081-8. [PMID: 12911667 DOI: 10.1046/j.1440-1746.2003.03088.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM The pathogenesis of ulcerative colitis (UC) is unclear, but abnormal infiltration of T lymphocytes in the colonic mucosa has been implicated in the mucosal tissue damage. The abnormal cytokine production because of a T helper (h)1/Th2 imbalance may play an important role in continuing inflammation in the colonic mucosa. In the present study, the expression of chemokine receptor 5 (CCR5) as a Th1 marker and a chemoattractant receptor-homologs molecule expressed on Th2 cells (CRTH2) were investigated in order to analyze impaired Th1/Th2 responses in the colonic mucosa of UC patients. METHODS Tissue samples were obtained by colonic biopsies from patients with UC or colonic polyps, with informed consent. Immunohistochemical analysis was performed on periodate, lysine-paraformaldehyde-fixed serial cryostat sections using the labeled streptavidin biotin method. Monoclonal antibodies against CD4, CCR5 or CRTH2 were used as primary antibodies. The number of cells expressing CD4, CCR5 or CRTH2 per unit area was calculated by using an image analyzer. RESULTS In the patients with UC, the numbers of CD4- and CCR5-positive cells were significantly increased in inflamed mucosa, and appeared to be correlated with the disease activity. The infiltration of CRTH2-positive cells was predominantly observed in the mildly inflamed or the margin of inflamed mucosa of UC patients. CONCLUSION There is a possibility that Th1 responses significantly occur in colonic mucosa with severe inflammation, while Th2 responses mainly occur with mild inflammation in UC patients. The Th1/Th2 imbalance in colonic mucosa may be related to the disease progression of UC.
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Affiliation(s)
- Koji Matsuzaki
- Second Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
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Monroe JA, Godwin JH, Godwin TA. HIV/AIDS case histories: iron deficiency anemia and altered iron metabolism in HIV infection. AIDS Patient Care STDS 2000; 14:667-9. [PMID: 11119434 DOI: 10.1089/10872910050206595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J A Monroe
- New York Presbyterian Hospital-Weill Cornell Center, New York, New York 10021, USA
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13
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Wall GC, Heyneman C, Pfanner TP. Medical options for treating Crohn's disease in adults: focus on antitumor necrosis factor-alpha chimeric monoclonal antibody. Pharmacotherapy 1999; 19:1138-52. [PMID: 10512063 DOI: 10.1592/phco.19.15.1138.30574] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Crohn's disease is a chronic inflammatory disorder that can present with symptoms throughout the gastrointestinal system. Though the etiology of Crohn's disease is unknown, genetic and environmental factors seem to play a role. An imbalance of proinflammatory versus antiinflammatory cytokines is responsible for many of the symptoms. Tumor necrosis factor alpha, a potent proinflammatory cytokine, plays a particularly important role. Several treatment modalities for Crohn's disease exist, recently including antitumor necrosis factor chimeric monoclonal antibody (cA2). Treatment for Crohn's disease, including data on the safety and efficacy of cA2, will be reviewed.
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Affiliation(s)
- G C Wall
- Department of Pharmacy Practice, Drake University, Des Moines, Iowa 50311-4505, USA
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Abstract
The colon is a frequent site of gastrointestinal complications in patients with HIV infection, and these colonic disorders increase in frequency as immunodeficiency worsens. The most common clinical manifestations of colonic disease in AIDS are diarrhea, lower gastrointestinal bleeding, and abdominal pain. Toxic megacolon, intussuseption, typhlitis, idiopathic colonic ulcer, and pneumatosis intestinalis also have been described. In the HIV-infected patient with preserved immunity, the most common cause of colitis is bacterial, but as the degree of immunodeficiency worsens, opportunistic pathogens (CMV, protozoa, mycobacteria, fungi) and neoplasms become more frequent. The frequent use of antibiotics, chemotherapeutic agents, and frequent hospitalization increase the susceptibility to cf2Clostridium difficule cf1colitis. Endoscopy plays an integral role in the management of many colonic disorders in AIDS.
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Yoshida EM, Owen DA. De Novo Crohn's disease in AIDS: Crohn's disease or Crohn's "syndrome"? J Clin Gastroenterol 1998; 26:93. [PMID: 9492878 DOI: 10.1097/00004836-199801000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Van Deventer SJ. Immunomodulation of Crohn's disease using TNF-αneutralizing monoclonal antibodies. Clin Nutr 1997; 16:271-5. [PMID: 16844608 DOI: 10.1016/s0261-5614(97)80011-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/1997] [Accepted: 09/16/1997] [Indexed: 11/27/2022]
Affiliation(s)
- S J Van Deventer
- Laboratory for Experimental Internal Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Lautenbach E, Lichtenstein GR. Human immunodeficiency virus infection and Crohn's disease: the role of the CD4 cell in inflammatory bowel disease. J Clin Gastroenterol 1997; 25:456-9. [PMID: 9412950 DOI: 10.1097/00004836-199709000-00013] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Crohn's disease is believed to have an immunologic basis. The importance of the CD4 cell in particular has been supported by several reports of patients whose symptoms of Crohn's disease resolved after a decline in CD4 count associated with human immunodeficiency virus (HIV) infection. A patient with known Crohn's disease, however, who was later infected with HIV, was reported to continue to have symptomatic Crohn's disease despite an eventual decrease in CD4 count to 84/mm3. We report the new onset of Crohn's disease in an HIV-infected patient with a CD4 count of 100/mm3. This report is the first to document the new onset of Crohn's disease in a patient with HIV and a CD4 count in the range commonly associated with various opportunistic infections and neoplasms. In addition, it is the first to confirm the recent finding that Crohn's disease may be active despite the profound immune deficiency associated with advanced HIV infection. Thus this report further challenges the significance of the CD4 cell in the pathogenesis of Crohn's disease.
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Affiliation(s)
- E Lautenbach
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
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