PANCREATITIS AGUDA EN PACIENTES INFECTADOS POR EL VIRUS DE LA INMUNODEFICIENCIA HUMANA

This study was designed to define the etiologial spectrum of acute pancreatitis in patients infected with HIV in our environment and to evaluate the relevance of cytomegalovirus as etiological agent. A retrospective analysis was first made of clinical, analytical, radiological and pathological findings of patients infected with HIV clinically diagnosed of acute pancreatitis (period 1984-1993). Then, clinical records of patients with necropsy proven CMV pancreatic involvement were retrospectively analyzed (period 1985-1992) to evaluate whether they had been diagnosed of acute pancreatitis when alive. Nine cases were diagnosed of acute pancreatitis. A presumptive etiology (didanosine) was considered in seven cases and idiopathic in two. Five patients died, two from causes directly related to acute pancreatitis. Necropsy was performed in two cases. Mortality was associated with the development of renal insufficiency or the appearance of three or more complications (p = 0.039). With regard to the second phase of the study CMV pancreatic involvement was demonstrated in 4 necropsies out of a total of 22 with evidence of CMV infection in one or more organs. None of these patients was diagnosed of acute pancreatitis when alive. Acute pancreatitis is an uncommon entity in patients infected with HIV. Presumptively, it could be attributed to didanosine therapy in most of our cases. The mortality rate was high, particularly when renal failure developed. In noe case was CMV involved as etiologic agent when the patient was alive, although necropsy showed that pancreas can be subclinically involved in the context of a CMV disseminated infection.