Frequency of pancreatic hyperamylasemia in human immunodeficiency virus-positive patients in the highly active antiretroviral therapy era

Abstract

Objectives: Increased frequency of hyperamylasemia has previously been reported in human immunodeficiency virus (HIV)-positive patients, but studies determined total amylase activity and were performed before the introduction of highly active antiretroviral therapy (HAART). We evaluated the frequency of pancreatic hyperamylasemia in a large HIV population mostly treated with HAART. Methods: The upper reference limit (URL) for pancreatic amylase (P-AMY) was derived from 299 healthy blood donors. A cross-sectional study was then performed on samples obtained from 1,548 consecutive patients referred to our infectious disease clinic to assess serum P-AMY and lipase concentrations. Of the patients, 94% were HIV, and most (92%) were taking HAART (HIVTx). Results: P-AMY URL was 51 U/L. The frequency of P-AMY increase did not significantly differ between HIV and HIV-populations (14.2% vs 15.2%, P=.91) or between HIVTx and HIVTx-(14.7% vs 8.9%, P=.11). In almost half (48.3% of HIV and 42.9% of HIV-) of hyperamylasemic patients, lipase was normal, indicating a non pancreatic origin of their P-AMY increase.Markedly elevated P-AMY (3 times the URL) was found in six HIV patients and in one HIV-patient: two had macroamylasemia, one acute pancreatitis, three (including the HIV-patient) chronic pancreatitis, and one chronic hyperamylasemia of undefined origin. Conclusions: In our study, both HIV and HIVTx do not show an increased frequency of P-AMY elevation. Frank pancreatic disease is rare in this clinical setting.