S Silver1, S M Wahl, B A Orkin, J M Orenstein. 1. Department of Pathology, George Washington University School of Medicine and Health Sciences, Washington DC 20037, USA.
Abstract
OBJECTIVE: To determine CD4+ T-cell count and circulating and tissue levels of HIV before and after surgery in a patient with recent-onset ulcerative colitis. STUDY DESIGN/ METHODS: CD4 lymphocytes and circulating and tissue HIV RNA levels were measured in an HIV-infected patient with ulcerative colitis before and after proctocolectomy. RESULTS: Approximately 3 weeks prior to surgery for ulcerative colitis that was unresponsive to corticosteroids, the patient's CD4 count was 930 cells/mm3 and fell to 313 cells/mm3 within 10 days; the viral burden was approximately 80,000 RNA copies/mL. Tissue macrophages and lymphocytes in biopsy and resection specimens were shown to express high levels of HIV RNA by in situ hybridization. Five days postoperatively, the patient became asymptomatic and was discharged on tapering prednisone without antiretroviral agents. After surgery, the patient's CD4 count progressively rose, while viral RNA levels precipitously dropped. At 3, 6, and 15 weeks postoperatively, CD4 and viral RNA counts were 622 cells/mm3 and 31,300 RNA copies/mL, 843 cells/mm3 and 11,400 RNA copies/mL, and 747 cells/mm3 and 1500 RNA copies/mL, respectively. CONCLUSIONS: Circulating levels of HIV and CD4+ cells, as well as tissue expression of HIV, apparently can be influenced by localized inflammatory processes such as those occurring in inflammatory bowel disease.
OBJECTIVE: To determine CD4+ T-cell count and circulating and tissue levels of HIV before and after surgery in a patient with recent-onset ulcerative colitis. STUDY DESIGN/ METHODS:CD4 lymphocytes and circulating and tissue HIV RNA levels were measured in an HIV-infectedpatient with ulcerative colitis before and after proctocolectomy. RESULTS: Approximately 3 weeks prior to surgery for ulcerative colitis that was unresponsive to corticosteroids, the patient's CD4 count was 930 cells/mm3 and fell to 313 cells/mm3 within 10 days; the viral burden was approximately 80,000 RNA copies/mL. Tissue macrophages and lymphocytes in biopsy and resection specimens were shown to express high levels of HIV RNA by in situ hybridization. Five days postoperatively, the patient became asymptomatic and was discharged on tapering prednisone without antiretroviral agents. After surgery, the patient's CD4 count progressively rose, while viral RNA levels precipitously dropped. At 3, 6, and 15 weeks postoperatively, CD4 and viral RNA counts were 622 cells/mm3 and 31,300 RNA copies/mL, 843 cells/mm3 and 11,400 RNA copies/mL, and 747 cells/mm3 and 1500 RNA copies/mL, respectively. CONCLUSIONS: Circulating levels of HIV and CD4+ cells, as well as tissue expression of HIV, apparently can be influenced by localized inflammatory processes such as those occurring in inflammatory bowel disease.