752 Should Gastroenterologists Screen Immunosuppressed IBD Patients for HIV?

Abstract

INTRODUCTION: HIV screening is recommended in all patients aged 15-75 years once in their lifetime and more frequently if at higher risk, including those taking immunosuppressive therapy. Gastroenterologists are uniquely positioned to improve screening rates since they prescribe immunosuppressive therapy to inflammatory bowel disease (IBD) patients. This study evaluated the frequency of HIV screening among IBD patients on immunosuppressive therapy at a university medical center. METHODS: A retrospective chart review of all IBD patients at an urban academic medical center seen during a 5-year period was performed. Patient gender, age, race/ethnicity, disease type, medication regimen, HIV screening and ordering physician specialty were obtained. Exclusion criteria were a previous HIV diagnosis or not receiving immunosuppressive treatment. A confidential database was created using Microsoft Excel with statistical analysis set at <0.05. This study was approved by IRB. RESULTS: Medical records of 392 IBD patients were reviewed. Of the 226 patients on immunosuppressant therapy, 97 (42.9%) males and 129 (57.1%) females were a mean age of 43.3 years. 58 (25.7%) had Crohn's Disease, 161 (71.2%) had ulcerative colitis and 8 (3.5%) had indeterminate colitis. 93 (41.2%) were screened for HIV. Three (0.004%) were HIV positive. African Americans were screened significantly more than non-African Americans (61.5%, 31.3%; P = 0.0001). There were no significant differences in HIV screening by gender (37.1% M, 44.2% F; P = 0.339); age (40.3% < 45 years, 42.4% ≥45 years; P = 0.784); or IBD type (51.7% CD, 37.9% UC; P = 0.0870). Primary care doctors screened for significantly more (51.6%) than obstetricians/gynecologists (22.6%; P = 0.0001) or other specialty physicians (9.7%; P = 0.0001) (Figure 1). CONCLUSION: Chronic colonic inflammation may contribute to CD4 lymphocyte depletion and negatively impact HIV outcome. While there are few HIV-infected patients in this study, HIV vulnerability may vary in other immunosuppressed populations. While this study is limited by size, single-institution design and focus on immunosuppressed IBD patients, it offers a foundation for future research and preventive health care efforts. It is important that all at-risk populations be screened for HIV with a focus on eliminating racial disparity. Gastroenterologists have the potential to significantly improve HIV testing for at-risk populations. Increased efforts are needed to heighten all physicians' awareness of HIV testing recommendations.