American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2019, 7(8), 162-166
DOI: 10.12691/ajmcr-7-8-3
Open AccessCase Report

CD4 Levels and Viral Load during Ulcerative Colitis Flares in Patients with Human Immunodeficiency Virus: A Case Series

Arroyo-Mercado Fray1, Likhtshteyn Michelle1, Huynh Chi Doan1, Chokshi Tanuj1, Chawla Gurasees S.1, Grossman Evan1, 2, Ramirez Miguel1, Ojeda-Martinez Hector1, 3 and McFarlane Samy I1,

1Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York

2Division of Gastroenterology and Hepatology, SUNY Downstate Health Sciences University, Brooklyn, New York

3Division of Infectious Diseases, SUNY Downstate Health Sciences University, Brooklyn, New York

Pub. Date: July 10, 2019

Cite this paper:
Arroyo-Mercado Fray, Likhtshteyn Michelle, Huynh Chi Doan, Chokshi Tanuj, Chawla Gurasees S., Grossman Evan, Ramirez Miguel, Ojeda-Martinez Hector and McFarlane Samy I. CD4 Levels and Viral Load during Ulcerative Colitis Flares in Patients with Human Immunodeficiency Virus: A Case Series. American Journal of Medical Case Reports. 2019; 7(8):162-166. doi: 10.12691/ajmcr-7-8-3

Abstract

Background: The “Remission Hypothesis” suggests that in patients with both HIV and UC an immunosuppressed state allows for the remission of UC and decreased number of flares. While the exact mechanism is unknown, this theory considers the relationship between CD4 count and flare progression. However, currently literature does not take into account the role that viral load might play in modulating flare activity. Methods: This is a case series including three patients with concurrent HIV and IBD at two large urban academic centers. A retrospective chart review was done and clinical information such as CD4+ count, viral load and flare symptoms were collected for each patient. Results: Three patients with a total of eleven UC flares were evaluated between the years of 2007 and 2018. Of the eleven flares, nine flares occurred while the viral load was undetectable, one flare occurred while the viral load was unknown, and one flare while the viral load was detectable. Conclusions: Nine out of eleven UC flares occurred while the patients’ viral loads were undetectable, which can support a “Remission Hypothesis” which is inclusive of viral load instead of CD4+ count. However, it is important to note that the disease progression of Patient 3 does not completely support this version of the hypothesis. While we cannot comment on whether the “Remission Hypothesis” is true or not, we do believe a more inclusive theory including viral load should be considered.

Keywords:
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