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Pancreatitis in HIV
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This study reports pancreatitis abnormalities may be emerging as a concern in HIV and may be an underestimated problem. In this study researchers looked at 1017 HIV+ persons and 334 had 1 or more occurrences of high pancreatic enzymes. 128 patients (12.6%) had 3-fold or higher elevations in enzymes for 6 or more months, with or without clinical symptoms. 113 of 1017 needed anti-HIV therapy discontinuation/modification and 65 required treatment for the pancreatitis. 42 of 113 had mild-to moderate symptoms. Acute pancreatitis occurred in only 8 patients without related death. The study authors suggest that having ongoing elevated enzymes of 3-fold or greater may be a warning sign. An additional factor to bear in mind is that HCV/HIV coinfected patients are starting to be treated with interferon + ribavirin (RBV). RBV is a NRTI and may increase ddI drug levels. A small study reported at ICAAC (December 2001) showed 10/25 had significant elevations of their lipase and amylase during therapy including 5 with clinical pancreatitis. Four of these 5, were on D4T/DDI and one was on D4T/3TC. The other 5 with asymptomatic elevations in amylase/lipase were on D4T, DDI or both. None were active alcohol users. All of the patients with clinical pancreatitis improved with stopping both HCV and HIV treatments. IFN and ribavirin should be used with caution in patients on the combination of D4T/DDI as the risk of pancreatitis seems to be increased.
Abstract: I-252. A Survey of Pancreatic Abnormalities (PA) during HIV Disease, in a Cohort of around 1000 Patients
Author- R Manfredi from the University of Bologna
Program abstract.
HIV+ p have multiple risk factors for PA including opportunistic disease and HIV itself, use of pancreotoxic drugs, alcohol or substances, HAART-related dyslipidemia and chronic hepatitis, but frequency and risk factors need further investigation in an unselected large p population. 1017 HIV+ p followed for ≥12 months (903 receiving antiretrovirals) had a quarterly laboratory workout including serum amylase, pancreas amylase, and lipase levels. The aim of our study is to assess the frequency, risk factors, clinical correlates and outcome of PA during a longitudinal survey.
Results: 334 p of 1017 (32.8%) had ≥1 occurrence of high pancreatic enzymes during the follow-up (12-197 months) (group 1), while in 128 cases (12.6%) a ≥ 3-fold elevation of serum enzymes persisting for ≥ 6 months with or without clinical and ultrasonographic features of pancreatitis, were shown (group 2). In a multivariate analysis, group 1 asymptomatic enzyme alteration was related to duration of HIV infection (p<.02), a ≥12-month anti-HIV therapy (p<.01), protease inhibitor use (p<.005), high triglyceridemia (p<.03), and a concomitant chronic hepatitis (p<.01), while group 2 situation was related to ≥ 6-month use of didanosine, stavudine, lamivudine or pentamidine (p<.05 to <.001), alcohol or drug use (p<.03), opportunistic disease (p<.02), chronic liver disease or gallstones (p<.01), prolonged HAART-related hyperlipidemia (p<.01), or a combination of these factors (p<.002). Of the 334 patients, 143 had repeated (2-8) episodes of elevated pancreatic enzymes, 113 needed anti-HIV therapy discontinuation/modification, 65 deserved treatment with gabexate and/or somatostatin, 42 experienced mild-to-moderate symptoms, but an acute pancreatitis occurred in 8 patients only, without any related death; these 3 last disease features had a higher frequency in group 2 (p<.001). The authors concluded pancreatitis abnormalities are emerging and are understimated problems in HIV+ patients, requiring further epidemiologic and clinical studies, to outline risk factors, and therapy and prevention strategies.
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