Involvement of the pancreas in AIDS: a prospective study of 109 post-mortems

Chehter, Ethel Zimberg; Longo, Maria Antonieta; Laudanna, Antônio Atílio; Duarte, Maria Irma Seixas

doi:10.1097/00002030-200009080-00001

Cited by 47 publications

(32 citation statements)

References 15 publications

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“…Factors associated with pancreatic disease in HIV infection include opportunistic infections, hepatitis coinfections, HIV infection itself and drugs, in particular didanosine (ddI) and zalcitabine (ddC) [8] abnormalities of the pancreas are seen in almost half of patients with AIDS in autopsy studies [9]. The annual incidence of acute pancreatitis in HIV-infected patients is around 0.6% [10].…”

Section: Introductionmentioning

confidence: 99%

Pancreatic exocrine insufficiency in HIV‐positive patients

et al. 2005

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We describe the management of a cohort of eight HIV-positive patients on antiretroviral medication with evidence of pancreatic insufficiency consisting of chronic diarrhoea and a low faecal elastase measurement. Patients and methodsTwenty-two patients with chronic diarrhoea for whom a faecal elastase measurement was available were identified retrospectively. We compared baseline demographic characteristics, antiretroviral treatment and symptoms of steatorrhea between patients with evidence of pancreatic insufficiency, i.e. a low faecal elastase measurement of o200 mg/g (cases), and patients with evidence of normal pancreatic function, i.e. a normal faecal elastase measurement of 4200 mg/g (controls). We describe the management of the patients with evidence of pancreatic insufficiency. ResultsOf the 22 patients, eight had evidence of pancreatic insufficiency, i.e. a low faecal elastase measurement. Comparing cases with controls, cases were more likely to have symptoms of steatorrhea (P 5 0.03) or to have lost weight (P 5 0.02). Cases were also significantly more likely to have taken didanosine (ddI) as part of their antiretroviral treatment when their symptoms started. Seven cases were treated with oral pancreatic supplements and all had symptomatic improvement of their diarrhoea. One patient stopped treatment with oral pancreatic supplements because of side effects without a relapse of symptoms; he had also stopped zalcitabine (ddC). ConclusionsWe believe that measurement of faecal elastase to detect pancreatic insufficiency should be part of the standard investigation of HIV-positive patients with chronic diarrhoea alongside assessment for other causes of diarrhoea. Faecal elastase measurements should be requested, in particular, in all patients with diarrhoea and weight loss, or symptoms of steatorrhea, and in those on treatment with an antiretroviral regime containing ddI. If the faecal elastase level is low, a switch of antiretroviral medication to a nonddI/ddC-containing regime should be considered and treatment with oral pancreatic enzyme therapy should be instituted.

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Section: Introductionmentioning

confidence: 99%

Pancreatic exocrine insufficiency in HIV‐positive patients

et al. 2005

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“…Pancreatic dysfunction caused by opportunistic microorganisms (Mycobacterium sp., Toxoplasma gondii, fungi, cytomegalovirus, Pneumocystis jiroveci) and by HIV were also frequent. 3 These patterns were confirmed in a different study, in which the ultrastructural evaluation of the pancreas in deceased AIDS patients revealed acinar atrophy, depletion of zymogen granules, an increase in lipofuscin pigment, Golgi complex rarefaction, increased and dilated rough endoplasmic reticulum, and an increase in size and number of mitochondria. Although these findings are compatible with exocrine pancreatic insufficiency and calorie-protein undernutrition, there is no clinical manifestation of pancreatic insufficiency.…”

Section: Introductionmentioning

confidence: 62%

Pancreatic Insufficiency in HIV: Is It Possible?

Chehter

Bacci

Alessi

et al. 2013

AIDS Research and Human Retroviruses

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Pancreatic involvement in AIDS is very important and common, but there are few studies in the literature concerning the pancreas in AIDS. Therefore, our research involves an important issue in the pancreatic field. The objective of the study was to evaluate the profile of HIV-infected patients with probable exocrine pancreatic insufficiency and its relation to the degree of human immunodeficiency virus (HIV) infection. This is a cross-sectional study carried out at Faculdade de Medicina do ABC in partnership with the basic health care unit Vila Guiomar in Santo André. We selected 118 individuals divided into four groups (a control group and three other groups composed of AIDS patients, separated according to CD4 levels); participants had an interview, completed a questionnaire, and had laboratory and imaging tests. The only clinical variables with significant differences among the studied groups were the use of highly active antiretroviral therapy (HAART), the incidence of opportunistic infections, the administration of chemoprophylaxis, and weight loss. There were no differences in the amylase, lipase, and steatocrit dosages among the groups. Levels of fecal elastase 1 were lower in the HIV patient groups (2, 3, and 4) when compared with the control group, although all of them showed average levels that were much higher than the cutoff point (200 μg/g). Only nonalcoholic individuals showed a relationship between diarrhea and alterations in elastase levels. A relationship between the use of HAART and exocrine pancreatic insufficiency in different phases of HIV infection could not be verified.

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“…Bile ducts in AIDS patients appear to be uniquely susceptible to opportunistic infections [11]. Ultrasonogra- "nutritional-like", inflammatory and both of these together [16]. The "nutritional-like" pattern (atrophy and steatosis) may be due to many factors such as nutritional characteristics induced by the HIV infection or related to the HIV virus itself.…”

Section: Form Non-invasive Inexpensive and Safe Imaging Technique Tmentioning

confidence: 99%

Correlation between Abdominal Ultrasonographic Findings and CD4 Cell Count in Adult Patients with HIV/AIDS in Jos, Nigeria

Eze¹,

Chom²,

Igoh³

et al. 2017

AMI

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CD + counts were studied. Two hundred (40%) of the patients had normal abdominal ultrasound, while 60% (300) had various abnormalities. The common abnormalities included increased liver parenchymal echogenicity in 25.0%, hepatomegaly in 23.4%, splenomegaly in 6.6%, increased splenic echogenicity in 6.2% and thickened gallbladder wall in 12.6%, elevated renal parenchymal echogenicity in 6.4%, enlarged kidneys in 2.6%, lymphadenopathy in 6.0%, and ascites in 2.4%. Pelvic abscess was the least pathology in 0.2%.Most of the findings did not correlate with the patients' 4 CD + count except for lymphadenopathy and ascites. Although abdominal ultrasound examination is invaluable in the management of these patients, however, it has not shown to be useful in predicting the patients' immune status.

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Involvement of the pancreas in AIDS: a prospective study of 109 post-mortems

Cited by 47 publications

References 15 publications

Pancreatic exocrine insufficiency in HIV‐positive patients

Pancreatic exocrine insufficiency in HIV‐positive patients

Pancreatic Insufficiency in HIV: Is It Possible?

Correlation between Abdominal Ultrasonographic Findings and CD4 Cell Count in Adult Patients with HIV/AIDS in Jos, Nigeria

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