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Crohn's Disease, HIV, and AIDS
American Journal of Gastroenterology - Volume 90, Issue 1 (January 1995) - Copyright © 1995 Elsevier - About This Journal
Letters to the editor
Crohn's Disease, HIV, and AIDS
To the Editor:
Recently, Bernstein et al.[1] reported a longstanding HIV-seropositive patient with cutaneous Kaposi's sarcoma (KS), a CD4 count of 480/mm3 , and newly diagnosed Crohn's ileitis. It was suggested that this case questioned the role of CD4 cells in the pathogenesis of Crohn's disease. It should be noted, however, that such a CD4 count in a patient with longstanding HIV infection is not particularly significant. To put the relationship between the total CD4 count and immunosuppression (as reflected by the risk of opportunistic infections) in perspective, prophylaxis for Pneumocystis carinii pneumonia is not recommended until the CD4 count falls below 200/mm3 [2] . Furthermore, the risks of Mycobacterium avium complex [3] and cytomegalovirus infection [4] increase when CD4 counts are less than 100/mm3 [4] . Although the reported patient did suffer from cutaneous KS, KS may not correlate with the extent of immunosuppression [5] .
At first glance, the experience of Bernstein et al. would appear to differ from that of James [6] , who reported a patient with Crohn's disease who went into remission after acquiring HIV. However, the circumstances of these two cases differ significantly. James' patient suffered symptomatic Crohn's disease for 18 yr before becoming HIV seropositive. His Crohn's disease went into and remained in remission despite progression to AIDS, with a fall in CD4 counts from 410/mm3 to 25/mm3 over 4 yr. The evolution of James' patient's Crohn's disease was thus followed as he became increasingly more immunosuppressed, whereas Bernstein's patient was newly diagnosed with Crohn's ileitis and is still relatively early in the evolution of his HIV disease.
The effect of HIV infection and its progression to AIDS on Crohn's disease remains unclear. The experience of Bernstein et al. provides us with the information that at least early in the progression of HIV infection, Crohn's disease may occur. It would be of interest to know the activity of Crohn's disease in this patient over time as his CD4 count inevitably diminishes.
Reprint requests and correspondence: J. Scott Whittaker, M.D., St. Paul's Hospital, 1081 Burrard Street, 371 Comox Building, Vancouver, BC, V6Z 1Y6, Canada.
Received July 22, 1994; accepted Sept. 27, 1994.
Eric M. Yoshida M.D. F.R.C.P.(C)
J. Scott Whittaker M.D., F.R.C.P.(C)
The Department of Medicine
University of British Columbia
Vancouver BC, Canada
REFERENCES
1. Bernstein BB, Gelb A, Tabanda-Lichauco R. Crohn's ileitis in a patient with longstanding HIV infection. Am J Gastroenterol 1994;89:937-9.
2. Masur H. Prevention and treatment of pneumocystis pneumonia. N Engl J Med 1992;327:1853-60.
3. Horsburgh CR Jr. Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. N Engl J Med 1991;324:1332-8.
4. Goodgame RW. Gastrointestinal cytomegalovirus disease. Ann Intern Med 1993;119:924-35.
5. Fauci AS, Lane CH. The acquired immunodeficiency syndrome (AIDS). In: Wilson JD, Braunwald E, Isselbacher KJ, et al., eds. Harrison's principles of internal medicine, 12th ed. New York: McGraw-Hill, 1991:1402-10.
6. James SP. Remission of Crohn's disease after human immunodeficiency virus infection. Gastroenterology 1988;95:1667-9.
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