Human immunodeficiency virus infection and Crohn's disease: The role of the CD4 cell in inflammatory bowel disease

Crohn's disease is believed to have an immunologic basis. The importance of the CD4 cell in particular has been supported by several reports of patients whose symptoms of Crohn's disease resolved after a decline in CD4 count associated with human immunodeficiency virus (HIV) infection. A patient with known Crohn's disease, however. who was later infected with HIV, was reported to continue to have symptomatic Crohn's disease despite an eventual decrease in CD4 count to 84/mm(3). We report the new onset of Crohn's disease in an HIV-infected patient with a CD4 count of 100/mm(3). This report is the first to document the new onset of Crohn's disease in a patient with HIV and a CD4 count in the range commonly associated with various opportunistic infections and neoplasms. In addition, it is the first to confirm the recent finding that Crohn's disease may be active despite the profound immune deficiency associated with advanced HIV infection. Thus this report further challenges the significance of the CD4 cell in the pathogenesis of Crohn's disease.