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. 2013 Feb;5(1):12-7.
doi: 10.4021/jocmr1040w. Epub 2013 Jan 11.

To Study the Clinical, Biochemical and Radiological Features of Acute Pancreatitis in HIV and AIDS

Shahzad Raza  1 , Naueen A Chaudhry, Jordan D Brown, Sina Aghaie, Damoun Rezai, Areej Khan, Paul De Leon Tan, Barbara J Berger
Affiliations

To Study the Clinical, Biochemical and Radiological Features of Acute Pancreatitis in HIV and AIDS

Shahzad Raza et al. J Clin Med Res. 2013 Feb.

Abstract

Background: Pancreatitis complicating HIV infection, even in the Highly Active Antiretroviral Therapy (HAART) era, remains a management challenge. We felt there is a need to discern patterns in the biochemical markers, radiological studies, co-infections, length of stay (LOS) in patients with HIV or AIDS AND pancreatitis.

Methods: This is a retrospective study conducted from June, 2008 to August, 2010 on patients admitted with acute pancreatitis to our hospital. We extracted and compared the following parameters: biochemical markers, HBV markers (surface antigen, core antibody and surface antibody), HCV antibody, radiological studies, and length of stay (LOS). The Balthazar Grade score was used to assess radiological severity of disease. We stratified the cohort into comparison subsets according to CD4 count.

Results: Ninety-four admissions met the criteria for HIV or AIDS AND pancreatitis; 67 unique patients comprised the cohort. Median age was 48 years (range, 23 to 60 years). Thirty seven (55%) were male, 30 (45%), female. Two third (n = 51) (76%) were African American. Known risk factors included a history of pancreatitis, 17 (25%); cholecystitis, 13 (19%); alcohol abuse, 25 (37%); Intravenous drug abuse, 18 (27%). Only 36 (38%) admissions were on HAART regimen. Biochemical features on admission were: WBC, 6,100/mm(3) (900 - 25,700); amylase, 152 U/L (30 - 1,344); lipase, 702.5 U/L (30 - 5,766), triglyceride, 65 mg/dL (57 - 400); glucose, 94 mg/dL (60 - 1,670); lactate, 2.3 mmol/L (1.09 - 5.49); AST, 61.5 U/L (9 - 1,950); LDH, 762 U/L (394 - 5,500); bicarbonate 19.5 mEq/L (3.3 - 82.7). Interestingly, 62% patients had normal pancreas on CT scan on admission. Of 67 individuals, hepatitis profile was available in 43, 21 (49%) were positive for HCV, 11 (26%) had markers for HBV. Four of 11 patients (36) with CD4 < 50 had evidence of persistent HBV (+core, -surface ab). Patients with CD4 < 200 have a median time for hospital course of 8 days (range 4 - 61 days) compare to 3 days in patients with CD4 > 200. P = 0.03 via t-test comparison. One patient with CD4 < 50 died due to acute pancreatitis.

Conclusion: Pancreatitis remains a major cause of morbidity in HIV-infected individuals. This study has provided detailed features in the HAART therapy era about the clinical, biochemical and radiological features of pancreatitis. Half of our patients were positive for HCV; additionally, 36% with CD4 < 50 had persistent HBV. As opposed to earlier studies, we did not find a female predominance. Patients with CD4 < 200 had a 2.67-fold increase length of stay. Future studies are needed for a closer look on viral cofactors which might precipitate episodes of acute pancreatitis.

Keywords: AIDS; HIV; Hepatitic C virus; Hepatitis B virus; Highly Active Antiretroviral Therapy (HAART); Pancreatitis.

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Figures

Figure 1
Figure 1
The representation of acute pancreatitis and Balthazar grade scoring system.
Figure 2
Figure 2
A and B: CT scan of acute pancreatitis in a 41-year-old female showing lucencies in the head of the pancreas and peripancreatic fluid stranding.
See this image and copyright information in PMC

References

    1. Dassopoulos T, Ehrenpreis ED. Acute pancreatitis in human immunodeficiency virus-infected patients: a review. Am J Med. 1999;107(1):78–84. - PubMed
    1. Riela A, Zinsmeister AR, Melton LJ, 3rd, Weiland LH, DiMagno EP. Increasing incidence of pancreatic cancer among women in Olmsted County, Minnesota, 1940 through 1988. Mayo Clin Proc. 1992;67(9):839–845. - PubMed
    1. Cappell MS, Marks M. Acute pancreatitis in HIV-seropositive patients: a case control study of 44 patients. Am J Med. 1995;98(3):243–248. - PubMed
    1. Dutta SK, Ting CD, Lai LL. Study of prevalence, severity, and etiological factors associated with acute pancreatitis in patients infected with human immunodeficiency virus. Am J Gastroenterol. 1997;92(11):2044–2048. - PubMed
    1. Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d'Arminio Monforte A, Knysz B. et al. Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet. 2003;362(9377):22–29. - PubMed

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