Pancreatic dysfunction and its association with fat malabsorption in HIV infected children

Abstract

Background-Nutrient malabsorption frequently occurs in HIV infected children, but very few studies have investigated exocrine pancreatic digestive capacity in these cases. Aims-To investigate pancreatic function in HIV infected children and to determine whether faecal fat loss, a prominent feature of intestinal dysfunction, is associated with pancreatic dysfunction. Patients-Forty seven children with HIV infection without apparent pancreatic disease and 45 sex and age matched healthy controls. Methods-Pancreatic function was evaluated by measuring elastase 1 concentration and chymotrypsin activity in stools by ELISA and colorimetric methods, respectively. Intestinal function was evaluated by measuring fat and protein loss by the steatocrit method and by faecal 1 antitrypsin concentration. Results-14 (30%) had abnormal pancreatic function tests: seven had isolated elastase activity deficiency, three isolated chymotrypsin deficiency, and four pancreatic deficiencies in both enzymes. Patient enzyme values were significantly lower than those of controls. Low faecal pancreatic enzymes were not associated with symptoms. Twelve children had steatorrhoea and four had increased 1 antitrypsin. Steatorrhoea was significantly associated with reduced faecal pancreatic enzymes. There was a significant negative correlation between elastase 1 concentration and steatocrit. Children with pathological faecal elastase 1 or chymotrypsin values did not diVer from the other HIV infected children with respect to nutritional and immunological status, stage of HIV disease, presence of opportunistic infections, or drug administration. Conclusions-Abnormal pancreatic function tests are a frequent feature of paediatric HIV infection; this condition is associated with steatorrhoea, which probably contributes to the disease.

Serum Pancreatic Enzymes in Human Immunodeficiency Virus-Infected Children: A Collaborative Study of the Italian Society of Pediatric Gastroenterology and Hepatology

“…On the other hand, as serum pancreatic enzyme levels are not an index of pancreatic digestive capacity, the present study does not permit any conclusion about the possibility of exocrine pancreatic insufficiency in HIV-infected children; however, another recent collaborative study of ours showed that 30% of HIV patients had low fecal levels of pancreatic elastase, and in these patients there was a higher frequency of steatorrhea (18).…”

Pancreatic Insufficiency in HIV: Is It Possible?

“…Nevertheless, when individuals with abnormal fecal elastase 1 are analyzed, suggesting exocrine pancreatic insufficiency, the presence of HIV was remarkable, despite the fact that there was no significant relationship among the groups with different CD4 levels, as shown in Table 3. These findings are similar to the ones already presented by Carrocio et al 13,14 Alcoholism also showed, as expected, a relationship with the fecal elastase 1 tests result. Carrocio et al could not demonstrate an inverse relationship between steatocrit and fecal elastase 1 levels 13 in HIV-positive adult patients.…”

“…Carrocio et al could not demonstrate an inverse relationship between steatocrit and fecal elastase 1 levels 13 in HIV-positive adult patients. The same relationship was significant when the studied group was composed of HIV-positive children 14 ; still, steatocrit values seem to decrease during therapy with orally administrated pancreatic enzymes, and the clinical improvements of some patients were considered significant. 5 The same study also could not demonstrate a relationship between the presence of altered fecal elastase 1 and the severity of HIV infection, or the presence or absence of undernutrition.…”

Effect of Bimonthly Supplementation With Oral Cholecalciferol on Serum 25-Hydroxyvitamin D Concentrations in HIV-Infected Children and Adolescents

“…11 This may reflect underlying alterations in intestinal absorption or vitamin D metabolism, both of which are documented in HIV. 12,13 Studies of higher dosages or shorter (eg, monthly) interval dosing seem to be justified given that 75% of the participants in the vitamin D treatment group had at least 1 monthly 25-OHD concentration <30 ng/mL.…”