CHU Nord à Marseille, service d’hépato-gastroentérologie, Chemin des Bourrely, 13015 Marseille, France
CHU de Nancy, service d’hépato-gastroentérologie, 1, Allée de Morvan, 54511 Vandœuvre-lès-Nancy, France
Inflammatory bowel diseases (IBD) are characterized by dysregulated immune response in the gut leading to inappropriate activation of the immune system which causes inflammatory damages. There is also a deficiency in the immune response in HIV infection because of immunosuppression due to CD4+ T cells depletion. However, there are very limited data concerning patients with both diseases simultaneously. Immunopathology of these two diseases implies complex interactions not fully understood. The effect of cellular and molecular modifications that IBD imparts in the setting of HIV is more unclear than the impact of HIV on IBD course. Indeed, it seems that both changes in innate and adaptative immunity in HIV patients lead to attenuation of IBD inflammation. The few data on clinical manifestations of patients who have both IBD and HIV seem to confirm this protective role of HIV on IBD course. Difficulties in predicting evolution of these two diseases when they are present in the same host also come from dysbiosis and microbial translocation which enhance HIV disease progression and constitute a vicious cycle of inflammation and immune activation. Furthermore, all studies on patients with IBD and HIV infection are retrospective and some are contradictory concerning the remission hypothesis of IBD due to CD4 count depletion caused by HIV. And even if it is a rare situation, we are deeply concerned for managing such patients. We fear infectious complications in those patients since they are already immnosuppressed by HIV. However, the very limited data available on IBD patients and data from rheumatology suggest a good safety profile and efficacy of immunosuppresants and biotherapy for HIV patients. Even though, anti-TNF therapy and vedolizumab could reduce VIH infectivity and so improve also VIH setting. But such hypothesis need validation.