P0971 - Inflammatory Bowel Disease Superimposed on HIV Infection: A Mirror Image of the Remission Hypothesis

Adejoke Johnson, MD¹, Alicia Phillipou, MD², Donald P. Kotler, MD^3
1Jacobi Medical Center/North Central Bronx Hospital, Bronx, NY; ²Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; ³Jacobi Medical Center/North Central Bronx Hospital/Albert Einstein College of Medicine, Bronx, NY

Introduction: HIV infection and inflammatory bowel disease (IBD) exist at opposite ends of a spectrum, immune deficiency vs. immune hyperactivity, but may coexist. Before the highly active antiviral agent era, IBD preceded HIV infection, and severe immune depletion to less than 200 cells/mm³ was accompanied by IBD remission, leading to the “Remission hypothesis.” Currently, HIV infection often precedes the development of IBD. We previously reported a case series of 9 patients with IBD engrafted on HIV infection, finding a mean CD4 count of 388 cells/mm³ and undetectable HIV viral loads in 6. This study examines the relationship between peripheral blood CD4 cell count and IBD development in the current treatment era in a larger case series.

Methods: We reviewed charts of 83 patients with concurrent HIV and IBD at our institution, focusing on 40 adult patients with documented ages of both diagnoses. Among these, 23 patients were diagnosed with HIV before IBD, with complete CD4 count data for 17 patients. Primary endpoints were CD4 count and viral load at IBD diagnosis. Secondary outcomes were mean CD4 counts during IBD flares and how the order of HIV and IBD diagnoses influenced IBD clinical characteristics and outcomes. Statistical analyses included Chi-square tests, P-values, and confidence intervals to assess group differences.

Results: Of 40 patients with HIV and IBD, 56% were diagnosed with HIV before IBD, and 44% were diagnosed with IBD before HIV. Mean age at IBD diagnosis was higher in the HIV-before-IBD group (45 years) compared to the IBD-before-HIV group (27 years, P < 0.001). Among 17 patients with HIV before IBD, the mean CD4 count at IBD diagnosis was 722 cells/µL, with 13 having CD4 counts > 500 and 16 having viral loads < 100 copies/mL. CD4 counts and viral loads were not available in the IBD before HIV group. The mean CD4 count during IBD flares was 466 cells/µL in both groups. There were no significant differences in clinical IBD characteristics, CD4 counts during disease flare, current CD4 counts, and viral loads based on the sequence of HIV and IBD diagnosis.

Discussion: Patients diagnosed with HIV before IBD have normal mean CD4 counts with virologic control at IBD diagnosis and during IBD flares, indicating preserved immune function. Effective antiviral therapy abolishes the effect of chronology on IBD activity in the current era. Instead, the development and activity of IBD is related to immune status.


Disclosures:


Adejoke Johnson, MD¹, Alicia Phillipou, MD², Donald P. Kotler, MD³. P0971 - Inflammatory Bowel Disease Superimposed on HIV Infection: A Mirror Image of the Remission Hypothesis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.