CD4 Levels and Viral Load during Ulcerative Colitis Flares in Patients with Human Immunodeficiency Virus: A Case Series

Arroyo-Mercado Fray¹, Likhtshteyn Michelle¹, Huynh Chi Doan¹, Chokshi Tanuj¹, Chawla Gurasees S.¹, Grossman Evan^{1, 2}, Ramirez Miguel¹, Ojeda-Martinez Hector^{1, 3} and McFarlane Samy I^1,

¹Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York

²Division of Gastroenterology and Hepatology, SUNY Downstate Health Sciences University, Brooklyn, New York

³Division of Infectious Diseases, SUNY Downstate Health Sciences University, Brooklyn, New York

Cite this paper

Arroyo-Mercado Fray, Likhtshteyn Michelle, Huynh Chi Doan, Chokshi Tanuj, Chawla Gurasees S., Grossman Evan, Ramirez Miguel, Ojeda-Martinez Hector and McFarlane Samy I. CD4 Levels and Viral Load during Ulcerative Colitis Flares in Patients with Human Immunodeficiency Virus: A Case Series. American Journal of Medical Case Reports. 2019; 7(8):162-166. doi: 10.12691/AJMCR-7-8-3

Abstract

Background: The “Remission Hypothesis” suggests that in patients with both HIV and UC an immunosuppressed state allows for the remission of UC and decreased number of flares. While the exact mechanism is unknown, this theory considers the relationship between CD4 count and flare progression. However, currently literature does not take into account the role that viral load might play in modulating flare activity. Methods: This is a case series including three patients with concurrent HIV and IBD at two large urban academic centers. A retrospective chart review was done and clinical information such as CD4+ count, viral load and flare symptoms were collected for each patient. Results: Three patients with a total of eleven UC flares were evaluated between the years of 2007 and 2018. Of the eleven flares, nine flares occurred while the viral load was undetectable, one flare occurred while the viral load was unknown, and one flare while the viral load was detectable. Conclusions: Nine out of eleven UC flares occurred while the patients’ viral loads were undetectable, which can support a “Remission Hypothesis” which is inclusive of viral load instead of CD4+ count. However, it is important to note that the disease progression of Patient 3 does not completely support this version of the hypothesis. While we cannot comment on whether the “Remission Hypothesis” is true or not, we do believe a more inclusive theory including viral load should be considered.

Keywords

format, microsoft word template, style, insert, template

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Skamnelos A, Tatsioni A, Katsanos KH, Tsianos V, Christodoulou D, Tsianos EV. CD4 count remission hypothesis in patients with inflammatory bowel disease and human immunodeficiency virus infection: a systematic review of the literature. Annals of Gastroenterology : Quarterly Publication of the Hellenic Society of Gastroenterology. 2015; 28(3): 337-346.
[2]	Stephan R. Targan, Fergus Shanahan and Loren C. Karp (eds.), Inflammatory Bowel Disease: From Bench to Bedside, 2nd Edition, 863-873.
[3]	Abramowitz, M., Ramachandran, R., Koczka, C., & Lawlor, G. (2013). P-068 YI Human Immunodeficiency Virus: CD4 Count Does Not Impact Ulcerative Colitis Relapse Risk. Inflammatory Bowel Diseases, 19.
[4]	Adiga A, Panikkath D, Nugent K (2016) A Review of Inflammatory Bowel Disease in Patients with Human Immunodeficiency Virus Infection. J AIDS Clin Res 7: 575.
[5]	Pospai D, Rene’ E, Fiasse R, et al. Crohn’s disease stable remission after human immunodeficiency virus infection. Dig Dis Sci. 1998; 43: 412-419.
[6]	Shoko C, Chikobvu D. A superiority of viral load over CD4 cell count when predicting mortality in HIV patients on therapy. BMC Infectious Diseases. 2019; 19(1).
[7]	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: 456-459.