Serum pancreatic enzymes in HIV-seropositive patients

Abstract

Serum concentrations of trypsin and elastase I were determined in 109 HIV Ab-positive patients (52 asymptomatic HIV-infected patients, 25 with lymphadenopathy syndrome, and 32 with acquired immunodeficiency syndrome) to assess the prevalence of possible pancreatic damage in these patients. Serum trypsin was abnormally elevated in 46 of the 109 patients (42.2%): 19 of the 52 asymptomatic HIV-infected patients (36.6%), 9 of the 25 with lymphadenopathy syndrome (36%), and 18 of the 32 with acquired immunodeficiency syndrome (56.3%). Serum elastase 1 was elevated in 14 of the 109 HIV Ab-positive patients (12.8%): 3 of the 52 asymptomatic HIV-infected patients (5.8%), 3 of the 25 with lymphadenopathy syndrome (12%), and 8 of the 32 with acquired immunodeficiency syndrome (25%). None of the patients with abnormally high serum pancreatic enzyme concentrations had clinically evident pancreatic disease. There was no statistically significant difference in serum levels of trypsin and elastase I between drug addicts and nonaddicts, between alcoholics and nonalcoholics, or between those with cytomegalovirus infection and those without. A significant inverse relationship was found between serum enzyme concentrations and the number of CD4+ lymphocytes. The results of this study show that high levels of serum trypsin and elastase are present in an elevated percentage of patients with acquired immunodeficiency syndrome, suggesting that the pancreas is frequently damaged in this disease. The finding of abnormally high serum enzyme concentrations not only in patients with AIDS, but also in asymptomatic carriers and in patients with lymphadenopathy syndrome suggests an association between HIV infection and the development of pancreatic lesions.

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

“…Although several studies or case reports have pointed to an etiologic role of drugs (6)(7)(8)16) or infections (1)(2)(3)(4)(5) in determining pancreatitis, our results are in agreement with those of Pezzilli et al (9), who observed a very high frequency of increased serum pan- creatic enzymes in HIV-infected adults, not correlated with drug administration or cytomegalovirus infection. Although several studies or case reports have pointed to an etiologic role of drugs (6)(7)(8)16) or infections (1)(2)(3)(4)(5) in determining pancreatitis, our results are in agreement with those of Pezzilli et al (9), who observed a very high frequency of increased serum pan- creatic enzymes in HIV-infected adults, not correlated with drug administration or cytomegalovirus infection.…”

HIV infection and the pancreas: risk factors and potential management guidelines

“…Already in the pre-HAART era, both endocrine abnormalities (leading to a poor glucose tolerance and possibly diabetes mellitus) and exocrine dysfunctions (potentially responsible for nutrient and especially fat malabsorption), were noticed in both adults and children. 16,18,32,33 In particular, a 1992 Italian survey showed elevated levels of trypsin and elastase-1 in 56.3 and 25% of examined patients respectively, in absence of signs and symptoms of pancreatisis, while again an inverse relationship was found with the severity of HIV-associated immunodeficiency. 16 All these disturbances are now much more difficult to monitorize and attribute to an eventual pancreatic involvement, since the introduction of HAART generated a broad spectrum of metabolic abnormalities involving glucose, insulin, insulin resistance, triglyceride and cholesterol metabolism and multiple other metabolic and endocrinologic pathways: they include the so-called lipodystrophy syndrome and fat redistribution syndrome 8,9,34,35 and multiple other disorders such as drug-induced diabetes mellitus, hepatic steatosis, lactic acidosis, metabolic syndrome and osteopaenia, most of them linked to strongly suspected mythocondrial abnormalities prompted by prolonged HAART.…”

“…16,18,32,33 In particular, a 1992 Italian survey showed elevated levels of trypsin and elastase-1 in 56.3 and 25% of examined patients respectively, in absence of signs and symptoms of pancreatisis, while again an inverse relationship was found with the severity of HIV-associated immunodeficiency. 16 All these disturbances are now much more difficult to monitorize and attribute to an eventual pancreatic involvement, since the introduction of HAART generated a broad spectrum of metabolic abnormalities involving glucose, insulin, insulin resistance, triglyceride and cholesterol metabolism and multiple other metabolic and endocrinologic pathways: they include the so-called lipodystrophy syndrome and fat redistribution syndrome 8,9,34,35 and multiple other disorders such as drug-induced diabetes mellitus, hepatic steatosis, lactic acidosis, metabolic syndrome and osteopaenia, most of them linked to strongly suspected mythocondrial abnormalities prompted by prolonged HAART. 12,36 For instance, a reduced pancreatic lipolytic activity was shown in patients with HAART-associated hypertriglyceridemia, 37 but an increasing amount of studies are aimed to find and discuss the possible pathogenetic pathways of antiretroviral-related toxicity, with special attention devoted to mitochondrial abnormalities 12,36 and factors related to comorbidity and concurrent drug administration.…”

“…1–4,7,17–19,22 However, both the frequency and severity of related signs and symptoms (abdominal pain with predominant back irradiation, diarrhoea, nausea and vomiting), remain a very low occurrence in this setting, 5,7,18 and diagnostic imaging (ultrasonography, contrast enhanced computerized tomography [CT] scan), may be hampered by co-existing pathologies and the frequent meteorism in the event of ultrasonography. 23 Therefore, although the overall frequency of pancreatic abnormalities was previously estimated to be 35–800 times greater than in the general population, 14,16 full-blown acute pancreatitis remained a somewhat infrequent clinical finding in HIV-infected patients through years (before and after the HAART era), 5,7,18,19 and severe or fulminant disease has been reported in very few cases, especially in the event of acutely drug-induced episodes. 3–5,7 As a consequence, most of HIV-associated pancreatic lesions were missed or under-estimated during lifetime, and were discovered only after death, especially in the pre-HAART era.…”

Patients with COVID-19 Interstitial Pneumonia Exhibit Pancreatic Hyperenzymemia and Not Acute Pancreatitis

“…Why this happened requires additional studies. similarly to COVID-19, the presence of pancreatic hyperenzymemia in other viral diseases has been reported; the Authors found that, in 78 patients with chronic liver diseases due to hepatitis C virus (HCV) or hepatitis b virus (HBV) infection, the serum amylase levels were abnormally elevated in 27 patients (35%; 22 liver cirrhosis, 5 chronic active hepatitis) whereas the serum lipase levels were elevated in only 16 patients (21%; 15 liver cirrhosis, 1 chronic active hepatitis) [18]; this also happens in mumps and HIV [19,20].…”