DOP17 HIV infection is associated with a less aggressive phenotype of inflammatory bowel disease. A multicenter study based on the ENEIDA registry.
Calafat Sard, M.(1,2)*;Súria, C.(3);Mesonero, F.(4);de Francisco, R.(5);Yagüe Caballero, C.(6);de la Peña, L.(7);Hernández-Camba, A.(8);Marcè, A.(9);Gallego, B.(10);Martín-Vicente, N.(11);Rivero, M.(12); Iborra, M.(13);Guerra, I.(14); Carrillo-Palau, M.(15);Madero, L.(16);Burgueño, B.(17); Montfort, D.(18);Torres, G.(19);Teller, M.(20);Ferrer Rosique, J.Á.(21);Vega Villaamil, P.(22);Roig, C.(23);Ponferrada, Á.(24); Betoré Glaría, E.(25);Zabana, Y.(2,26); P. Gisbert, J.(2,27);Alcaide, N.(28);Camps, B.(29);Legido, J.(30);González Vivo, M.(31);Bosca-Watts, M.M.(32);Pérez-Martínez, I.(5);Casas Deza, D.(6,33);Guardiola, J.(7);Arranz Hernández, L.(8); Navarro, M.(34);Gomollon, F.(2,10);Cañete, F.(1,2); Mañosa, M.(1,2);Domènech, E.(1,2);
(1)Hospital Universitari Germans Trias i Pujol, Gastroenterology department, Badalona, Spain;(2)CIBERehd, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain;(3)Hospital Clínic Universitari de València- Universitat de València, Gastroenterology Department, Valencia, Spain;(4)Hospital Universitario Ramón y Cajal, Gastroenterology Department, Madrid, Spain;(5)Hospital Universitario Central de Asturias- Instituto de Investigación Sanitaria del Principado de Asturias ISPA, Gastroenterology Department, Oviedo, Spain;(6)Hospital Universitario Miguel Servet, Gastroenterology Department, Zaragoza, Spain;(7)Hospital Universitari de Bellvitge, Gastroenterology Department, L'hospitalet de Llobregat, Spain;(8)Hospital Universitario Nuestra Señora de Candelaria, Gastroenterology Department, Santa Cruz de Tenerife, Spain;(9)Hospital de Sant Joan Despí Moisès Broggi, Gastroenterology Department, Sant Joan Despí, Spain;(10)Hospital Clínico Universitario «Lozano Blesa»- Instituto de Investigación Sanitaria- IIS Aragón, Gastroenterology Department, Zaragoza, Spain;(11)Hospital Universitario de Galdakao, Gastroenterology Department, Galdakao, Spain;(12)Hospital Universitario Marqués de Valdecilla- Instituto de Investigación Marqués de Valdecilla IDIVAL, Gastroenterology Department, Santander, Spain;(13)Hospital Universitari i Politècnic la Fe de València, Gastroenterology Department, Valencia, Spain;(14)Hospital Universitario de Fuenlabrada e IdiPAZ, Gastroenterology Department, Fuenlabrada, Spain;(15)Hospital Universitario de Canarias, Gastroenterology Department, La Laguna, Spain;(16)Hospital General Universitario Dr Balmis de Alicante. ISABIAL, Gastroenterology Department, Alicante, Spain;(17)Hospital Rio Hortega, Gastroenterology Department, Valladolid, Spain;(18)Consorci Sanitari de Terrassa, Gastroenterology Department, Terrassa, Spain;(19)Hospital Universitari Arnau de Vilanova de Lleida, Gastroenterology Department, Lleida, Spain;(20)Althaia- Xarxa Assistencial Universitària de Manresa, Gastroenterology Department, Manresa, Spain;(21)Hospital Universitario Fundación Alcorcón, Gastroenterology Department, Alcorcón, Spain;(22)Complexo Hospitalario Universitario de Ourense, Gastroenterology Department, Ourense, Spain;(23)Hospital Universitari de la Santa Creu i Sant Pau, Gastroenterology Department, Barcelona, Spain;(24)Hospital Universitario Infanta Leonor, Gastroenterology Department, Madrid, Spain;(25)Hospital Universitario San Jorge, Gastroenterology Department, Huesca, Spain;(26)Hospital Universitari Mútua de Terrassa, Gastroenterology Department, Terrassa, Spain;(27)Hospital Universitario de la Princesa- IIS-Princesa- UAM- Madrid, Gastroenterology Department, Madrid, Spain;(28)Hospital Clínico de Valladolid, Gastroenterology Department, Valladolid, Spain;(29)Hospital de Granollers, Gastroenterology Department, Granollers, Spain;(30)Complejo Asistencial de Segovia, Gastroenterology Department, Segovia, Spain;(31)Hospital Parc de Salut Mar, Gastroenterology Department, Barcelona, Spain;(32)Hospital Clínic Universitari de València- Universitat de València, Gastroenterology Department, València, Spain;(33)Instituto de Investigación Sanitaria de Aragón IISA., Gastroenterology, Zaragoza, Spain;(34)Hospitalde Sant Joan Despí Moisès Broggi, Gastroenterology Department, Sant Joan Despí, Spain; on behalf of GETECCU.
Background
The coexistence of immune-mediated diseases and non-pharmacological immunosuppression states are rare and might determine the natural history of the disease and therapeutic decisions of the physician. IBD guidelines recommend screening for human immunodeficiency virus (HIV) before starting immunosuppressive treatment, but data on the impact of HIV infection on IBD and its management in the era of biological drugs are scarce. Therefore, our aim was to describe IBD phenotype, immunosuppressive requirements, and prevalence of opportunistic infections (OI) in patients with IBD and coexistent HIV infection.
Methods
Case-control, retrospective, multicenter study including all IBD patients with available HIV serology on the ENEIDA registry (a large, prospectively maintained database of the Spanish Working Group in IBD –GETECCU). IBD patients with positive HIV serology were selected (HIV+) and compared to HIV seronegative IBD patients (controls), matched 1:3 by year of IBD diagnosis, age, gender and type of IBD). Demographic, clinical IBD characteristics, therapeutic requirements, OI and IBD complications were registered.
Results
Eighty-eight HIV+ IBD patients and 264 controls were included. In the whole cohort, 81% were men, 56.8% had ulcerative colitis (UC), 36.4% Crohns’ disease (CD) and 6.8% IBD unclassified. Median age at IBD diagnosis was 38 years (IQR 30-47), median age at HIV infection diagnosis was 36 years (IQR 30-42), 46.3% being were firstly diagnosed of IBD. Among UC patients, HIV+ had a lower proportion of extensive disease (24.5% vs 44.8%; P=0.002), and a higher proportion of proctitis (38.8% vs. 16.6%; P=0.002) than controls, without differences on disease proximal progression (7.7% vs 7.9%). Among CD patients, HIV+ presented a higher proportion of colonic involvement than controls (40.6% vs 12,6%, P=0.002) and lower penetrating behavior (10.7% vs 25%; ns). HIV+ had a lower proportion of extraintestinal manifestations (10.7% vs 25.4%; P=0.005). Although it was not statistically significant, a trend towards a lower proportion of hospitalizations (25.6% vs 35.3%) and IBD complications (6.3% vs. 9.2%) in HIV+ was observed. Regarding IBD therapeutic requirements, immunosuppressant (40.5% vs 58.7%; P=0.003) and biological drugs (28.3% vs 42.8%; P=0.020) were used less frequently among HIV+ than among controls. Conversely, HIV+ had a higher rate of OI (38.3% vs 17.8%; P<0.001) and malignancies (12.5% vs 8.3%, ns) than controls.
Conclusion
The coexistence of IBD and HIV infection seems to be associated with a less aggressive IBD phenotype and a lower use of immunosuppressants and biologicals but with a remarkable rate of OI.