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Risk factors and clinical and therapeutic issues of pancreatic abnormalities during HIV infection

Background

After a decade of combination antiretroviral therapy (cART) availability, the epidemiological-clinical features of HIV-associated pancreatic abnormalities changed over time.

Methods

The frequency, risk factors, and clinical-therapeutic features of pancreatic alterations were assessed in an observational, prospective case-control study involving 1,081 HIV-infected patients (pts) followed for >12 months.

Summary of results

166 pts with elevated and/or prolonged laboratory anomalies were focused on to assess pancreatic disease during the cART era. The 435 pts (40.2%) who experienced >1 episode of pancreatic laboratory abnormality had a longer duration of seropositivity and protease inhibitor (PI) exposure, a more frequent immunodeficiency, AIDS diagnosis, chronic liver-biliary disease, and hypertriglyceridemia, while no relation was found with the duration-type of administered nucleoside analogues, when compared with the 646 controls, who never developed pancreatic anomalies. Among the mentioned 435 pts, elevated-prolonged laboratory alterations eventually associated with signs of organ involvement occurred in 166 cases (38.2%), and were related to the administration of ddI, d4T, 3TC, pentamidine, cotrimoxazole, or antimycobacterial therapy, cytotoxic chemotherapy, substance-alcohol abuse, opportunistic infections, chronic liver-biliary disease, a PI-based cART, and hypertriglyceridemia. However, no difference occurred between the 46 pts with clinical-imaging evidence of pancreatic involvement and the remaining 120 asymptomatic pts. Although recurrences of enzyme alterations involved 69.6% of pts, in only 30.1% was a change of the antiretroviral-antimicrobial therapy needed. An acute but uncomplicated pancreatitis occurred in 9/46 symptomatic pts (19.6%). A 2–4-week gabexate and/or octreotide administration (performed in 79/166 cases: 47.6%), achieved a significant laboratory, clinical, and imaging cure-improvement in 82.3% of cases, with a better success rate of combined (gabexate+octreotide) vs. single (gabexate or ocreotide) therapy. A significantly reduced tendency to disease recurrences, and a better tolerability of antiretroviral regimens, were also found.

Conclusion

Epidemiological-pathogenetic studies are needed to assess the trend of pancreatic abnormalities in the cART era, and their relationship with continued antiretroviral-antimicrobial chemotherapy. This research field appears somewhat neglected, so that observational studies and controlled trials are lacking. The indications to gabexate-octreotide during HIV disease deserve investigation.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Manfredi, R., Calza, L. Risk factors and clinical and therapeutic issues of pancreatic abnormalities during HIV infection. JIAS 11, P165 (2008). https://doi.org/10.1186/1758-2652-11-S1-P165

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  • DOI: https://doi.org/10.1186/1758-2652-11-S1-P165

Keywords

  • Pancreatitis
  • Octreotide
  • Nucleoside Analogue
  • Pentamidine
  • Prolonged Laboratory