Exocrine pancreatic function and fat malabsorption in human immunodeficiency virus-infected patients

Background: Nutrients malabsorption frequently occurs in human immunodefici ency virus (HIV)infected patients, but very few studies have investigated e xocrine pancreatic digestive capacity in these patients. We therefore evalu ated the frequency of exocrine pancreatic impairment and its eventual relat ion with fat malabsorption in HIV-infected patients, Methods: Thirty-five H IV-infected patients (30 male, 5 female; mean age +/- standard deviation, 3 3.6 +/- 7.2 years) and 51 sex- and age-matched controls without gastroenter ologic diseases were studied. In all subjects fecal elastase 1 (EL-1) was a ssayed, and fecal fat excretion was evaluated with the steatocrit test. Res ults: Nineteen of 35 (54%) HIV-infected patients showed subnormal EL-1 valu es, whereas all the controls had normal values; furthermore, EL-1 values we re significantly lower in patients than in controls: mean (95% confidence i ntervals), 207 (164-251) mu g/g Versus 312 (291-332) mu g/g (P < 0.0001). I ncreased fecal fat excretion was observed in almost all (25 of 35) HIV-infe cted patients, and an inverse but not significant correlation was found bet ween fecal EL-1 and steatocrit values. No association was found between red uced fecal EL-1 and the severity of HIV disease or nutritional and immunolo gic status. Opportunistic infections and drug administration had no influen ce on EL-1 concentrations in stools. Conclusions: Reduced exopancreatic fun ction is frequent in HIV-infected patients but does not seem to be a major factor contributing to fat malabsorption.