PANCREATIC DUCTAL CHANGES IN HIV-INFECTED PATIENTS

Background: AIDS-related sclerosing cholangitis occurs in patients wit h advanced immunodeficiency, but ductal pancreatic alterations have no t been evaluated in large series. Methods: Twenty-nine consecutive pat ients with a mean age of 33 years underwent ERCP for biliary work-up. Complete pancreatography was obtained in 28 patients. Serum levels of amylase were increased in 17 patients prior to ERCP. The mean duration of HIV infection was 6.1 years (range 3 to 10 years). Results: Fiftee n patients (53.6%) had pancreatographic changes classified according t o the Cambridge classification (stage 1, 4 cases; stage 2, 7 cases; st age 3, 4 cases). Dilatations, irregularities, short stenoses of the ma in pancreatic duct, and irregularities of side branches were the most frequent abnormalities. Fourteen of these 15 patients (93.3%) had chol angitis and a CD4 cell count of less than 60 per cubic millimeter. Ris k factors for pancreatic damage were similar in patients with and with out pancreatographic changes. Opportunistic infection occurred in 14 o f 15 patients with pancreatographic changes (candida, cytomegalovirus, cryptosporidia, microsporidia, and mycobacteria). Conclusion: Abnorma l pancreatographies were found in about half of the HIV-infected patie nts who underwent ERCP. The pancreatographic features were suggestive of chronic pancreatitis and were closely related to the presence of AI DS-related sclerosing cholangitis.