Efficacy of oral pancreatic enzyme therapy for the treatment of fat malabsorption in HIV-infected patients

Background: Nutrient malabsorption is a negative prognostic factor in acqui red immunodeficiency syndrome and recent studies have shown that pancreatic insufficiency is a codetermining factor of malabsorption. Aims: To evaluate the effectiveness of open-label oral pancreatic enzyme su pplementation therapy in acquired immunodeficiency syndrome patients with f at malabsorption. Patients and methods: Twenty-four consecutive patients with human immunodef iciency virus infection and fat malabsorption were recruited (11 males, 13 females; median age, 9.1 years). Faecal fat loss was evaluated by steatocri t assay at entry to the study (T-0), after 2 weeks (T-1) without pancreatic enzyme treatment and after a further 2 weeks (T-2) of treatment with pancr eatic extracts (Creon 10 000 at a dose of 1000 units of lipase per gram of ingested dietary fat). Faecal elastase-1 and chymotrypsin were assayed at e ntry. Results: Six patients (25%) had abnormally low elastase-1 and/or chymotryps in faecal concentration. In all patients, steatocrit values were elevated a t both T-0 and T-1. Five patients proved intolerant to pancreatic enzyme tr eatment because of the onset of abdominal pain, and therapy was discontinue d. In the 19 patients who concluded the study, steatocrit values during pan creatic enzyme treatment (T-2) were significantly lower than at entry (P<0. 0001). At T-2, in eight of 19 patients, steatocrit values were within the n ormal limit and the frequency of cases cured or improved on pancreatic enzy me therapy (at T-2) was significantly higher than that observed during the previous study period without enzyme treatment (T-1) (P<0.01). A positive s ignificant correlation was found between steatocrit values at entry and the Centers for Disease Control class (P<0.0005); also, the decrease in steato crit values during pancreatic enzyme therapy (difference between steatocrit value at T-2 and steatocrit value at T-0) positively correlated with the C enters for Disease Control class (P<0.05). Conclusions: This pilot, open-label study showed that pancreatic enzyme sup plementation therapy is highly effective in reducing faecal fat loss in hum an immunodeficiency virus-infected patients with nutrient malabsorption. Fu rther double-blind studies must be undertaken to verify these results and, if they are confirmed, pancreatic enzymes can be added to our weapons in th e fight against human immunodeficiency virus-associated nutrient malabsorpt ion.