Abnormalities of serum amylase and lipase in HIV-positive patients

We sought to study asymptomatic pancreatic enzyme abnormalities in patients with human immunodeficiency virus (HIV) infection.

Serial serum amylase and lipase determinations were performed in ambulatory HIV-seropositive patients in whom pancreatitis was not suspected.

Eighty-six patients were enrolled in the study. Fifty-two patients (60%) were found to have abnormal amylase or lipase values on at least one determination. Only 12 (14% of all patients) had a more than twofold elevation of pancreatic enzymes. Seven patients had transient elevations of lipase within 3 months after the initiation of antiretroviral therapy. Independent factors associated with abnormal pancreatic enzymes were: positive serology for chronic hepatitis B or C, history of intravenous cotrimoxazole administration for the treatment of Pneumocystis carinii pneumonia, stage B of HIV disease, and HIV risk factors other than male homosexuality (mainly intravenous drug use). None of the patients developed clinical pancreatitis.

Asymptomatic mild to moderate elevations of amylase or lipase are common in HIV-positive patients, and are usually associated with positive serology for chronic hepatitis B or C, and medications, especially antiretrovirals and intravenous cotrimoxazole.