Hello Dr Henry,

I was diagnosed with UC about 6 months after being diagnosed as HIV +. I have pan ulcerative colitis which is the worst form. Despite being on Asacol 3 x per day and having just finished a tapered high dose course of Prednisolone, my symptoms have not changed. I am still suffering from daily diarrhea and urgent bowel movements.

My GI doctor has mentioned using Azathiopine, which is obviously an immunosuppressant. I am currently on meds (over 1yr) and are undectable with CD4 of around 500. I am very reluctant to go on Azathiopine for a minimum of 2yrs as i am concerned about the effect it will have on my immune system. What do you suggest? Should i avoid this medication?

There certainly is concern about a negative effect of azathioprine on the immune status of HIV infected persons on effective HIV medication though many HIV+ patients have been treated with azathrioprine (in transplant, lupus, inflammatory bowel disease patients) with decent results (careful monitoring required). I generally tell the GI consultant to offer the optimal treatment for the underlying colitis and I will try to work with them on maintaining optimal HIV status as well. KH