The spectrum of pancreatic pathology in patients with AIDS

Clinical studies have indicated that pancreatitis is a common cause of morbidity in patients with acquired immunodeficiency syndrome (AIDS). In order to assess the morphologic basis of this pancreatic disease, we reviewed 82 autopsies performed on AIDS patients at The Johns Hopkins Hospital. Pancreatic lesions were detected in 52 (65%) of these, and could be classified into three broad categories: acinar dilatation by inspissated secretions (24 cases), acute pancreatitis (recent or remote, 18 cases), and opportunistic infections or cancers affecting the pancreas (23 cases). To better assess the importance of these lesions, particularly the acinar dilatation, 82 age-race-sex-matched controls were evaluated in a blinded comparison. The frequency of acinar dilatation and acute pancreatitis was similar in cases and controls. Only one control was found to have an opportunistic infection, and no opportunistic cancer was detected in controls. There were no unexplained lesions found in the AIDS cases which might be attributed to direct human immunodeficiency virus (HIV) infection. These data confirm clinical reports that the pancreas is frequently affected in AIDS patients. We propose that the clinical evidence of pancreatitis reported in these patients may be due to the frequent opportunistic lesions demonstrated by this series.