Inflammatory Bowel Disease in Adult HIV-Infected Patients-Is Sexually Transmitted Infections Misdiagnosis Possible?

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.

Crohn’s disease in human immunodeficiency virus-infected patient: A case report

“…The authors of a similar case report and the other authors of a comprehensive study mentioned that specifically, CD4 + cells are responsible for intestinal inflammation, while HIV reduces the CD4 + count. Moreover, CD relapse rates reduce in the presence of HIV[ 2 , 6 ]. In our case, the patient still suffered from CD symptoms; however, during rehospitalization, the clinical manifestations were not as severe.…”

“…Furthermore, some bacterial populations ( E. coli for instance) are known to expand in size during IBD because of dysbiosis, which is even more profound among HIV-infected individuals[ 16 ]. In addition, HIV and IBD can cause the mucosal barrier of the bowel to lose its integrity and become more permeable[ 2 ]. In this case, it might have led to E. coli bacteremia and sepsis, which required the clinical pharmacologist to quickly manage the situation with intensive antibiotic therapy that, in the end, accounted for the improvement of the patient’s health status.…”

“…Similarly, as another clinical case shows, the early detection of HIV risk factors in a patient who is newly diagnosed with IBD could help initiate appropriate treatment tactics and prepare for opportunistic infections ahead of time[ 17 ]. Even if the patient is HIV-negative, other sexually transmitted infections should be tested for because their symptoms and endoscopic findings can be similar to those of IBD[ 2 ]. As mentioned earlier, PE prophylaxis could also be taken into consideration whenever corticosteroid treatment is prescribed for IBD patients with a higher PE risk[ 9 ].…”

“…It is classified as either ulcerative colitis (UC) or Crohn’s disease (CD). Both IBD and HIV infection can coexist in the same person, although this coexistence is rarely observed; therefore, the relationship between one and the other and the impact of this relationship on the immune system are not fully understood yet[ 1 , 2 ]. However, there are speculations that the HIV-modified CD4 + lymphocyte count plays its role in altering the course of IBD alongside increasing the likelihood of opportunistic infections occurring[ 2 , 3 ].…”

Infectious proctitis: what every gastroenterologist needs to know

“…Considering that both conditions can coexist and in order to reduce the cases of IP incorrectly diagnosed as IBD, some authors recommend HIV testing for every MSM patient with IBD suspicion. Moreover, all patients with IBD in the colorectal tract, even confirmed by endoscopy and histopathology, should be tested for STIs using molecular and serological methods [ 49 ]. Patients initially diagnosed with IBD not responding to standard therapy as expected, should also be tested for STIs.…”