Thalidomide Treatment for Refractory HIV‐Associated Colitis: A Case Series

Abstract

Thalidomide has been used as a treatment for various human immunodeficiency virus (HIV)-associated and non-HIV-associated illnesses, generally in cases in which inflammatory disease is refractory to standard therapy. Here, we discuss the successful use of thalidomide in 3 patients with severe, idiopathic HIV-associated colitis.

Opportunistic disorders of the gastrointestinal tract in the age of highly active antiretroviral therapy

“…One hundred thirty-four (134) rectal biopsies were obtained from 116 patients. Specific diagnoses were rare, that is, CMV (6) and polyps (8). Most patients had nonspecific diagnoses, such as ulcers (24), acute (8) or chronic inflammation (8), and NSHA (24).…”

“…Specific diagnoses were rare, that is, CMV (6) and polyps (8). Most patients had nonspecific diagnoses, such as ulcers (24), acute (8) or chronic inflammation (8), and NSHA (24). Rare biopsies showed pseudomembranes, bacterial enteropathy, spirochetosis, or KS.…”

“…The only "potential" pathogen identified by IHC, in situ hybridization (ISH), and TEM has been HIV itself. The most successful treatments have been intralesional corticosteroids and especially the antitumor necrosis factor drug thalidomide [8].…”

“…There are also idiopathic ulcerative processes, for example, distal esophagus, ileum, and rectum, that maybe due to HIV itself because only viral particles have been found in these lesions [7]. In some cases, thalidomide, an anti-tumor necrosis factor agent, and corticosteroids have been used successfully to treat such ulcers [8]. Although the incidence of KS has decreased markedly with the advent of highly active antiretroviral therapy (HAART), the incidence of primary extranodal, non-central nervous system lymphomas has not changed significantly.…”

Overview of Biologic Response Modifiers in Infectious Disease

“…Only around 2 percent of Caucasians carry such a mutation. Another potent TNF inhibitor, thalidomide, has been used in trials in HIV patients [22]. More recently, thalidomide and its immunomodulatory imide analogs such as Actimid, Lenalidomide , Pomalidomide and Revlimid, have been used as anti-inflammatory drugs.…”