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Chronic colitis associated with human immunodeficiency virus infection
M C Hing1, C Goldschmidt, J M Mathijs
1Bruce Hall Department of Gastroenterology, St Vincent's Hospital, Darlinghurst, NSW.
Insights
Chronic colitis in human immunodeficiency virus (HIV) patients presents unique pathology distinct from other inflammatory bowel diseases. This condition may represent a new entity directly related to HIV infection of the colon.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pathology
Background:
- Chronic colitis can manifest in individuals with human immunodeficiency virus (HIV) infection.
- Understanding the clinical and pathological features of this condition is crucial for diagnosis and management.
Purpose of the Study:
- To provide a clinical and pathological description of chronic colitis associated with HIV infection.
- To investigate the potential of HIV as a causative agent in chronic colitis.
Main Methods:
- A retrospective case review of six patients with HIV and chronic colitis.
- Colonoscopy, colonic biopsies, and molecular techniques (in situ hybridization, Southern blot) were employed.
- Histopathological analysis assessed inflammatory infiltrate and crypt architecture.
Main Results:
- Patients presented with chronic diarrhea, rectal bleeding, and abdominal pain.
- Colonoscopy revealed diffuse proctocolitis; biopsies showed persistent inflammation without features typical of ulcerative colitis, Crohn's disease, or other infections.
- HIV nucleic acid was detected in colonic biopsies of four patients, suggesting a direct role of the virus.
Conclusions:
- Chronic colitis in HIV-infected individuals may represent a distinct clinical entity.
- This entity appears to be related to direct infection of the colon by HIV.
- Further research is warranted to fully characterize this HIV-associated colitis.
Objective:
A clinical and pathological description of chronic colitis associated with human immunodeficiency virus (HIV) infection.
Design:
A retrospective case review.
Setting:
Tertiary referral institution and specialist gastroenterology practice.
Patients:
A series of six patients with human immunodeficiency virus infection and chronic colitis observed for up to four years.
Results:
The six patients had chronic diarrhoea for longer than six months, rectal bleeding, abdominal pain and stool leukocytosis. The mucosal pattern on colonoscopy showed diffuse proctocolitis, consisting of contact bleeding, superficial ulcerations, exudates, and/or loss of vascular pattern. Colonic biopsies showed a persisting diffuse colitis characterised principally by a mixed inflammatory cell infiltrate (mononuclear cells and neutrophils) and essentially preserved crypt architecture after six to 39 months of histological follow-up. The histopathology over this time frame was not typical of ulcerative colitis or Crohn's disease, nor of the conventionally described forms of infective colitis. HIV nucleic acid was identified by insitu hybridisation in colonic biopsies from four patients. In two of three patients tested, the presence of HIV DNA was confirmed by Southern blot analysis. No other microbial agent could be demonstrated as the cause of diarrhoea. At presentation all patients had CD4+ lymphocyte counts greater than 265 x 10(6)/L and none had the acquired immunodeficiency syndrome. Four patients have gone into remission, the other two patients were not in remission at four and a half to five years after onset.
Conclusion:
We suggest that chronic colitis may represent a new entity related to infection of the colon with human immunodeficiency virus.