POZ – Treatment News : Thalidomide Helps HIV-Related Colitis
Posted by pozlife on May 23, 2008
Three HIV-positive patients with ulcerative colitis had complete resolution of the disease after treatment with thalidomide, according to an article to be published in a forthcoming issue of Clinical Infectious Diseases.
Thalidomide has a checkered history. It was universally banned after it was found in the early 1960s to lead to severe birth defects when given to pregnant women. In the last decade, however, it has made a comeback and is gaining in popularity as a treatment for some cancers and a variety of disorders characterized by an overly active immune system. One such disease common in people with HIV is oral aphthous ulcers, also known as canker sores. Ulcerative colitis, which is also a disease of immune over-stimulation, is characterized by sores in the colon. These sores are often a source of severe abdominal pain and chronic diarrhea, and can be difficult to treat.
Leann Johnson, MD, from North Manchester General Hospital in Manchester, England, and her colleagues describe the medical history of three HIV-positive men treated for ulcerative colitis between 2003 and 2005. One of the men had been infected with HIV for 15 years and was heavily treatment experienced, while the other two were more recently infected and had never taken antiretroviral (ARV) therapy. In each of the three cases, a variety of colitis treatments were first attempted, including ARV therapy, anti-inflammatory drugs and drugs to treat bacterial and viral infections. None were successful. Two of the men were scheduled for colon surgery but joined a thalidomide study just before surgery, in a last-ditch attempt to treat the colitis.
In all three cases, the men’s abdominal pain and diarrhea began to resolve within days after starting treatment with thalidomide, at a dose of 100 mg per day. After several months of treatment, tests revealed that their colons had healed considerably, and the men were ultimately able to stop the thalidomide treatment without the colitis coming back.
Johnson’s team writes that further research is needed both in people with HIV and in HIV-negative patients with colitis to determine the efficacy of thalidomide treatment. Nevertheless, these results are hopeful for people with HIV-associated colitis that has not responded to standard treatment.