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Pancreatitis in children infected with human immunodeficiency virus
K I Koranyi1, M T Brady, K Stock
1Department of Pediatrics, College of Medicine, Ohio State University, Columbus, USA.
Insights
Pancreatitis occurred in 23.8% of HIV-infected children, often linked to severe immunosuppression. Serum lipase levels were more effective than amylase for diagnosis in this pediatric population.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Virology
Background:
- The incidence and characteristics of pancreatitis in children with Human Immunodeficiency Virus (HIV) infection are not well-established.
- Understanding pancreatitis risk factors and diagnostic markers in pediatric HIV is crucial for patient management.
Purpose of the Study:
- To determine the incidence of pancreatitis in HIV-infected children.
- To identify potential risk factors and clinical features associated with pancreatitis in this cohort.
- To evaluate the utility of serum lipase versus amylase in diagnosing pancreatitis.
Main Methods:
- Retrospective review of medical records for 42 children with HIV infection over a 6-year period.
- Analysis of clinical data, including CD4+ T-cell counts, opportunistic infections, and medications.
- Comparison of serum lipase and amylase levels in children diagnosed with pancreatitis.
Main Results:
- Pancreatitis developed in 10 out of 42 (23.8%) HIV-infected children.
- Severe immunosuppression (CD4+ < 100 cells/mm3) was noted in nine affected children.
- Elevated serum lipase levels were more frequently observed than elevated amylase levels.
- One case showed rapid resolution upon discontinuation of dideoxynosine (ddI).
Conclusions:
- Pancreatitis is a significant concern in HIV-infected children, particularly those with advanced disease.
- The etiology of pancreatitis in this population may be multifactorial, including opportunistic infections and antiretroviral medications.
- Serum lipase determination is a more sensitive marker than serum amylase for detecting pancreatitis in HIV-infected children.
Abstract:
The incidence of pancreatitis in HIV-infected children is not well known. Medical records of 42 children with HIV infection followed at Children's Hospital during a 6-year period were reviewed. Pancreatitis (elevated serum lipase levels) developed in 10 children (23.8%). Three children acquired HIV infection from vertical transmission and seven from contaminated blood products (hemophiliacs). Nine were severely immunosuppressed (CD4+ of < 100 cells/mm3). Lipase values were more often elevated than amylase values. The clinical course was protracted and severe in two children, one had four recurrences, and seven had only a single episode of pancreatitis lasting a few weeks. Opportunistic infections were present in four children and seven were receiving medications previously implicated as cause of pancreatitis. Discontinuation of dideoxynosine (ddI) in one child led to rapid resolution of pancreatitis, but continuation of medications in the other children did not alter the course. The etiology of pancreatitis may be multifactorial. Severe and prolonged clinical course is associated with advanced HIV infection. Determination of serum lipase is more useful than serum amylase for identifying those with pancreatitis.