IS HIV STATUS RELEVANT IN ACUTE PANCREATITIS

• Published in: South African journal of surgery Vol. 55; no. 2; p. 52
• Main Authors: Prodehl, L A, Brand, M B, Mauser, M
• Format: Journal Article
• Language: English
• Published: South Africa 01.06.2017
• ISSN: 0038-2361

HIV positivity and antiretroviral (ARV) treatment have been described as significant causes of acute pancreatitis prevalence and predictors of poor outcomes. Most data are from the late 1990s and early 2000s, prior to widespread roll out of ARVs and newer agents. This study assessed if there is still a significant difference between HIV positive (HIV+) and negative(HIV-) patients in acute pancreatitis in the presentation and outcomes of acute pancreatitis. A retrospective review of a prospectively collected database of patient admission data. The data was collected by an interviewer-administered questionnaire. All patients presenting to Chris Hani Baragwanath Academic Hospital with acute pancreatitis were eligible for inclusion. Of 148 patients, 56 (37.8%) were HIV+ and 92 (62.2%) HIV-. Median age at presentation was 40.5 (18-77); HIV+ 37 (18-61), HIV- 41.5 (19-77)(p = 0.14). Men comprised the majority (58.1%); HIV+ and HIV- (53.6% vs. 60.9%), (p = 0.40). Median BMI on presentation was 23.6 (16.4-41.4), no significant difference between HIV+ ( 23.3 [16.4-38.4]) and HIV-(24.3 [16.7-41.4]) (p = 0.65). Smoking was equal, HIV+ (51.1%) and HIV- (57.1%) (p = 0.59). Alcohol use was not significantly different, HIV+ (88.2%), HIV- (77.3%) (p = 0.20). The predominant aetiology was alcohol, HIV+ (63.6%) and HIV- (58.2%); followed by gallstones, HIV+ (23.6%) and HIV- (27.5%), (p = 0.26). Contrary to prior studies ARVs were not significant (3.6%). The revised Atlanta severity score was severe in 45.3%, HIV+ (46.4%) and HIV- (44.6%) (p = 0.8). The median admission CRP was 49 (< 1-447) in HIV+ and 27 (< 1-406) in HIV- (p = 0.44). Length of stay did not differ significantly, all patients stayed a median of 9 days (0-731), HIV+ 6 days (1-601) and HIV- 12.5 days (0-731), (p = 0.39). CD4 counts were available on 36 of the HIV+ patients and viral load on 19. The range of CD4 levels was 3 to 911 (median 259), and viral loads 0-3 160 000 (median 48). 37 patients were on ARVs and their CD4 ranged 14-681, those not on treatment ranged 3-911. In the present era of ARV regimens and universal roll-out, there is no significant difference between HIV+ and HIVpatients in the presentation, aetiology and outcomes of acute pancreatitis.