STUDY OF PREVALENCE, SEVERITY, AND ETIOLOGIC FACTORS ASSOCIATED WITH ACUTE-PANCREATITIS IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

Objectives: Patients with the human immunodeficiency virus (HIV) disea se can develop pancreatic gland inflammation from HIV infection and re lated causes, or from factors totally independent of it, The incidence and severity acute pancreatitis in patients with HN diseases and the frequency of associated etiological factors have not been examined in any detail. The purpose of this study was to (a) determine the prevale nce of acute pancreatitis, (b) evaluate severity of pancreatic gland i nflammation, (c) identify commonly associated etiological factors with acute pancreatitis, and (d) examine the relationship between CD4 lymp hocyte counts and serum pancreatic enzyme levels (amylase and lipase) in patients with HIV disease. Methods: We examined the medical records of 321 patients with HIV disease seen at Sinai Hospital of Baltimore between July of 1993 to June of 1994. Data collected from these record s included clinical, laboratory, and radiologic features of pancreatit is, staging of HIV disease, risk factors, CD4 lymphocyte counts, medic ations associated with the presence of opportunistic infections, Kapos i's st-coma, and lymphoma. Results: From 321 patients with HIV disease , 45 patients developed at least one episode of acute pancreatitis as defined by clinical and laboratory criteria during the 1-yr period, A statistically significant negative correlation was found between serum pancreatic enzyme level and the number of CD4 lymphocytes (r = -0.15, p < 0.05 for serum amylase; r = -0.2, p < 0.05 for serum lipase). Fur thermore, patients with asymptomatic HIV infection or CD4 lymphocyte c ount > 500 mm(3) did not develop asymptomatic hyperamylasemia or acute pancreatitis. Furthermore, the presence of gallstones, active injecti on drug use, pentamidine therapy, Pneumocystis carinii, Mycobacterium avium intracellulare correlated significantly (p < 0.001) with the dia gnosis of acute pancreatitis, Conclusions: A detailed review of medica l records of patients with HIV disease seen in a community hospital in 1 yr (1993-1994) suggests a high incidence (14%) of mild to moderatel y severe acute pancreatitis. In this group of patients, pancreatic gla nd inflammation is commonly associated with gallstones, intravenous dr ug abuse, pentamidine intake, and Pneumocystis mocystis carinii and My cobacterium avium intracellulare infections. In addition, marked reduc tion in CD4 lymphocyte count is associated with increase in serum panc reatic enzyme levels (amylase, lipase activity) suggesting pancreatic gland inflammation or altered pancreatic enzyme turnover.