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P210. IBD and HIV: Does CD4 count remission hypothesis count?

A. Skamnelos1, A. Tatsioni2, K. Katsanos1, V. Tsianos1, D. Balomenos1, S. Liamas1, D. Christodoulou1, E. Tsianos1, 1University of Ioannina, Gastroenterology, Ioannina, Greece, 2Ioannina Medical School, Greece & Tufts University Medical School, Department of Internal Medicine, Ioannina, Greece

Background

Patients with inflammatory bowel disease (IBD) and Human Immunodeficiency Virus (HIV) infection have shown controversial data concerning the remission hypothesis of IBD due to CD4 count depletion caused by HIV. The aim was to review the literature to investigate the hypothesis whether low CD4 count due to HIV is related to IBD remission.

Methods

We systematically searched Pubmed for studies reporting on HIV infection in IBD patients. We extracted characteristics of IBD and HIV disease course and CD4 counts.

Results

Thirteen papers (2 case controls studies, 2 case series and 9 case reports) were eligibleincluding 47 patients with IBD and HIV infection (43 males 4 females; 27 Crohn's, 19 ulcerative colitis, 1 Indeterminate Colitis). The IBD diagnosis criteria were heterogeneous among studies. Remission was reported for patients with IBD and HIV infection in 5 studies, including 4 case control case series and 1 case report. Four out of 5 studies with IBD patient cases reported remission related to the CD4 count remission hypothesis but only 2 of them explicitly reported the CD4 count cut-off point (500 cells/microlitre and 200 cells/mm3 respectively). On the contrary, 7 case reports described an active IBD course or relapse even in patients under immunosuppression.

Conclusion

Current literature cannot support or reject the DC4 count remission hypothesis in IBD patients with HIV infection. Prospective studies using criteria on IBD and HIV disease course are needed.