final program.qxd - Parallels Plesk Panel

PP 3.13
Crohn's disease onset in a HIV/HCV co-infected woman taking pegylated interferon
plus ribavirin
Marco Bongiovanni1, Roberto Ranieri1, Stefano Ferrero2, Francesca Casanova3,
Antonella d'Arminio Monforte1
1Clinic of Infectious Diseases, S. Paolo Hospital, University of Milan, Italy; 2Pathology
Unit, S. Paolo Hospital, University of Milan, Italy; 3Unit of Internal Medicine, S. Paolo
Hospital, University of Milan, Italy
Background
The combination of pegylated interferon (Peg-IFN) and ribavirin is the optimal option to
treat HCV-infection in subjects with or without HIV co-infection. Despite a clear correlation
between Crohn's disease and HCV-infection, only few cases of Crohn's disease have
been reported in HIV-infected subjects.
Case report
We report the case of a woman co-infected with HCV (genotype 3a) and HIV due to
heterosexual intercourses. In October 2005, the patient was still naïve for antiretroviral
treatment because of good immuno-virological parameters (CD4: 517 cells/mm 3 ;
HIV-RNA: 390 copies/mL), but she had a quite advanced HCV disease (liver biopsy:
ISHAK score 10; fibrosis index 2), so that a treatment with Peg-IFN (180 mcg/weekly) plus
ribavirin (800 mg/daily) was initiated. HCV-RNA was 980000 copies/mL, AST 107 UI/L and
ALT 68 UI/L; an abdomen ultrasound showed hepatic steatosis. HCV-RNA became
undetectable and hepatic enzymes normalized after one month of treatment. Three
months later, the patient was admitted to our Clinic for fever, melena and abdominal pain.
Blood test showed anemia (Haemoglobin: 10,2 g/dL) and elevation of C-reactive protein
(90 mg/dl, normal value < 5); CD4 cells decreased to 275 cells/mm3 and HIV-RNA was
undetectable. The physical examination revealed a mild abdominal pain and a body
temperature of 39° C. Abdomen radiography and ultrasound were negative as were blood
and stool examinations. Endovenous treatment with ciprofloxacin and metronidazole was
started. A colonoscopy showed an inflammatory feature with aftous reactions and
necrotic areas 60 centimetres far from anus. The histological examination showed
erosions of the epithelial mucosa with marked acute and chronic inflammation with
muscolaris mucosae involvement suggesting an inflammatory bowel disease. Mesalazine
(800 mg 4 times daily) was started followed by a rapid clinical recovery. Peg-IFN and
ribavirin were continued because of the early virological response and the recovered
clinical conditions.
Conclusions
Crohn's disease seems to have an immune pathogenesis. The onset of this event in HIV
subjects usually occurs in patients with high CD4. An association between interferon
therapy and onset of Crohn's disease has been described in HCV mono-infected subjects.
At our knowledge, this is the first report describing the onset of Crohn's disease in a
HCV/HIV-infected subjects taking Peg-IFN plus ribavirin. This event does not seem
associated with HIV-infection for the decrease of CD4 and for the good virological control.
The role of HCV-infection is also opinable for the early virological response to anti-HCV
therapy. Finally, the symptoms of Crohn's disease occurred three months after Peg-IFN
plus ribavirin were started, probably a too short period to determine immune modifications.
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