IDDF2022-ABS-0045 Etiopathogenetic features of acute pancreatitis in HIV-positive patients. (2nd September 2022) - Plotkin, Dmitry
Abstract : Background: Acute pancreatitis is a common nosological entity among hospital patients in Russia. The main factors influencing its occurrence are alimentary causes (alcohol consumption and fatty foods) as well as the migration of bile concretions. Pancreatitis is also registered quite often among people living with HIV. Unfortunately, the coverage of antiretroviral therapy doesn't exceed 80% of HIV-positive patients and some of them aren't committed to treatment which largely determines the etiopathogenetic features of pancreatitis in this category of patients. Methods: The diagnostic findings and anamnestic data in two groups of patients with acute pancreatitis admitted to the clinic in 2019–2020 were analyzed: 362 HIV-negative patients and 79 HIV-positive patients. The cause of pancreatitis was determined based on anamnesis analysis, ultrasound results, MSCT and laboratory data. Results: In the first group of patients' alimentary factors were the cause of pancreatitis in 48.6% of cases, bile concretions in 29.8% of cases and in 21.6% of cases it wasn't possible to accurately determine the cause of pancreatitis. Among HIV-infected patients we observed a completely different spectrum of etiopathogenetic factors of pancreatitis, and in patients whose CD4+ cell count exceeded 200 in mcl (42 people) the causes of pancreatitis didn't differ much from HIV-negative individuals: 45.2% – alimentary causes, 21.4% – bile concretions, 14.3% – toxicity of ART and in 19.1% the cause of pancreatitis was unclear. In HIV-positive patients with low immune status (CD4+ cells less than 200) the causes of pancreatitis were distributed as follows: 24.3% – alimentary causes, 10.8% – bile concretions, 51.4% – inflammation associated with exposure to HIV, cytomegalovirus and Mycobacterium tuberculosis, and only in 13.5% of cases the cause of pancreatitis was unclear. Conclusions: Acute pancreatitis among people with HIV infection and low immune status is associated with the manifestation of opportunistic infections in almost half of the cases. The diagnostic program in such patients should be expanded by determining the number of CD4+ lymphocytes, MSCT of the abdomen, as well as quantitative testing for immunoglobulins G and M to cytomegalovirus, immunological tests for tuberculosis infection for the timely appointment of specific antiviral and anti-tuberculosis therapy.