May 10, 2022
Does concomitant HIV impact IBD treatment and outcomes?
IBD patients with HIV receive less intense therapy yet have similar disease course.
Guillo L, Uzzan M, Beaugerie L, et al. Impact of HIV Infection on the Course of Inflammatory Bowel Disease and Drug Safety Profile: A Multicenter GETAID Study. Clin Gastroenterol Hepatol. 2022;20(4):787–92.e2; https://www.cghjournal.org/article/S1542-3565(20)31719-5/fulltext
Prior research has suggested that IBD in patients with human immunodeficiency virus (HIV) may have a milder course. To further elucidate the impact of HIV on IBD, researchers in France retrospectively studied 65 adults with IBD and concomitant HIV and 130 HIV-uninfected adults with IBD who were treated at multiple centers in that country in 2019 and 2020.
HIV-infected patients were more likely to have proctitis and they were less likely to have left-sided colitis, pancolitis, ileitis and ileocolitis. HIV-infected patients were more likely to receive 5-ASA (78.5% vs. 59.2% of HIV-infected vs. non-infected, respectively; p=0.0032), and less likely to receive immunosuppressants (33.8% vs. 59.2%, respectively; p=0.0011) or biologics (47.7% vs. 78.5%, respectively; p<0.001).
Despite differences in therapy, the severity of the IBD course was similar in the two groups. Specifically, a composite measure of Crohn’s disease (CD) severity including IBD-related hospitalizations, bowel complications, and intestinal surgery was no different in CD patients infected with HIV (Hazard Ratio [HR], 1.3; 95% Confidence Interval [CI], 0.7–2.4; p=0.45). Similarly, a composite measure of ulcerative colitis (UC) severity that included IBD-related hospitalization or colectomy was no different among UC patients with HIV (HR, 1.1; 95% CI, 0.5–2.7; p=0.767).
Overall rates of immunosuppressant- and biologic-related adverse events were similar among HIV-infected and HIV-uninfected individuals with IBD.
Study Design: Retrospective cohort
Funding: Not stated
Allocation: Not applicable
Level of Evidence: 2b