ABSTRACT
In HIV-seropositive individuals, the incidence of acute pancreatitis may achieve 40% per year, higher than the 2% found in the general population. Since 1996, when combined antiretroviral therapy, known as HAART (highly active antiretroviral therapy), was introduced, a broad spectrum of harmful factors to the pancreas, such as opportunistic infections and drugs used for chemoprophylaxis, dropped considerably. Nucleotide analogues and metabolic abnormalities, hepatic steatosis and lactic acidosis have emerged as new conditions that can affect the pancreas. To evaluate the role of antiretroviral drugs to treat HIV/AIDS in a scenario of high incidence of acute pancreatitis in this population, a systematic review was performed, including original articles, case reports and case series studies, whose targets were HIV-seropositive patients that developed acute pancreatitis after exposure to any antiretroviral drugs. This association was confirmed after exclusion of other possible etiologies and/or a recurrent episode of acute pancreatitis after re-exposure to the suspected drug. Zidovudine, efavirenz, and protease inhibitors are thought to lead to acute pancreatitis secondary to hyperlipidemia. Nucleotide reverse transcriptase inhibitors, despite being powerful inhibitors of viral replication, induce a wide spectrum of side effects, including myelotoxicity and acute pancreatitis. Didanosine, zalcitabine and stavudine have been reported as causes of acute and chronic pancreatitis. They pose a high risk with cumulative doses. Didanosine with hydroxyurea, alcohol or pentamidine are additional risk factors, leading to lethal pancreatitis, which is not a frequent event. In addition, other drugs used for prophylaxis of AIDS-related opportunistic diseases, such as sulfamethoxazole-trimethoprim and pentamidine, can produce necrotizing pancreatitis. Despite comorbidities that can lead to pancreatic involvement in the HIV/AIDS population, antiretroviral drug-induced pancreatitis should always be considered in the diagnosis of patients with abdominal pain and elevated pancreatic enzymes.
Em HIV-soropositivos, a incidência de pancreatite aguda pode chegar até 40% ao ano, o que é consideravelmente maior que na população geral, cuja incidência é de 2%. A partir de 1996, com a introdução da terapia antirretroviral combinada, conhecida pela sigla HAART (highly active antiretroviral therapy), o espectro de fatores nocivos ao pâncreas, como infecções oportunistas e uso de drogas para sua quimioprofilaxia, diminuiu consideravelmente. Análogos nucleotídeos e anormalidades metabólicas, esteatose hepática e acidose láctica despontaram como novas condições que podem acometer o pâncreas. A fim de avaliar o papel das drogas antirretrovirais para tratamento do HIV/AIDS na incidência elevada de pancreatite aguda nessa população, foi realizada revisão sistemática, com inclusão de artigos originais, relatos e séries de caso, cujos alvos de estudo eram pacientes HIV-soropositivos que evoluíram com pancreatite aguda após exposição a alguma das drogas que compõem o esquema antirretroviral. Essa associação foi confirmada após exclusão de outras possíveis etiologias e/ou recorrência do episódio de pancreatite aguda após reexposição ao fármaco suspeito. Zidovudina, efavirenz e os inibidores de protease são suspeitos de levar a uma pancreatite secundária à hiperlipidemia. Já os análogos nucleotídeos da transcriptase reversa, apesar de serem potentes inibidores da replicação viral, possuem grande espectro de efeitos colaterais, entre eles a mielotoxicidade e a pancreatite aguda. Didanosina, zalcitabina e estavudina já foram reportados como produtores de pancreatite crônica e aguda, tendo risco elevado com dose cumulativa. Didanosina com hidroxiureia, álcool ou pentamidina são fatores de risco adicionais, podendo induzir a uma pancreatite fatal, embora pouco frequente. Além disso, outras drogas usadas para profilaxia de doenças oportunistas relacionadas à AIDS, como sulfametoxazol-trimetoprima e pentamidina, podem produzir pancreatite necrotizante. Apesar das comorbidades que podem levar ao acometimento pancreático na população com HIV/AIDS, pancreatite medicamentosa desencadeada por drogas antirretrovirais sempre deve ser considerada no diagnóstico diferencial desses pacientes que se apresentam com dor abdominal e elevação das enzimas pancreáticas.
Subject(s)
Female , Humans , Male , Acquired Immunodeficiency Syndrome/drug therapy , Anti-HIV Agents/adverse effects , Antiretroviral Therapy, Highly Active/adverse effects , Pancreatitis/chemically induced , Acquired Immunodeficiency Syndrome/complications , Acute Disease , Comorbidity , Risk FactorsABSTRACT
【Objective】To investigate the clinical characteristics of acute pancreatitis(AP) in Guangzhou area.【Methods】A retrospective analysis was carried out in 273 AP inpatients hospitalized in the First Affiliated Hospital of Guangzhou University of TCM from 1996 to 2004.The onset time,seasonal distribution,syndrome patterns and prognosis of PA,and sex,age and disease course of the patients in Guangzhou area were carefully analyzed.【Results】The incidence rate of AP in Guangzhou was increased in recent years,lower in summer while higher in winter.The male and the female had the same incidence(the ratio approaching to 1∶1).In terms of age,there was a lower incidence in teenagers and the highest in the group aged 20 to 39.The incidence reached a plateau in the group aged 40 to 79 and sharply decreased in the group aged 80 and over.In terms of disease course,the majority of the AP patients were much improved and left hospital within 1～2 week(s) and the frequency valve arrived at the peak about one week later.In terms of the prognosis,72.9% of the patients were cured after timely traditional Chinese and western medicine treatment,the fatality rate being 2.9%.In terms of syndrome patterns of AP,damp-heat in the liver-gallbladder accounted for 69.9%,liver and Qi stagnation 11.7%,phlegm-stasis blocking collaterals 7.8%,deficiencycold in fu-organs 7.3% and excess in Yangming fu-organ 3.4%.【Conclusion】The incidence rate of AP in Guangzhou area tends to increase in recent years,the young and the middle aged have the highest incidences,most cases are manifested as damp-heat in the liver-gallbladder pattern,and AP attack usually occurs in winter and spring,and holidays,indicating that AP attack has a relation with unhealthy lifestyle,especially improper diet,in developed areas.This should be taken into consideration by the department concerned.