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THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 2 | 8 and 42 (66%) HIV negative. Their demographic and socio-economic data are compared in Table 1. Table 1: Characteristics of Chronic Pancreatitis Patients Whole group HIV positive HIV negative HIV positive vs HIV negative N= 64 N =22 N =42 p-value Age years (Range) 48.9(30-69) 45(31-64) 50.7(30-69) 0.008 Age<45 years old 22 13 9 0.038 Male:Female 54:10 19:3 34:8 0.494 Body Mass Index (kg/m2) 19.0 (14.8-24.5) 18.9 (16.4-22.7) 19.1 (14.8-24.5) 0.77 CD4 count (cells/mm3) (Median(Range)) 463 (110-988) - - Antiretroviral therapy 13 - - Social History Education (completed standard 8/ Grade 10) 33 12 21 0.231 Currently employed 17 5 12 0.60 Currently married/ life partner 27 7 20 0.887 ECOG score 2(1-3) 2(1-3) 2(1-3) 0.229 HIV infected patients were younger than uninfected patients (p = 0.008), being more likely to be less than 45 years old (p = 0.038). Forty two of the patients were men (84%) but the proportion of males and females did not differ between the groups. The mean BMI of the 2 groups did not differ. More than half the patients had grade 10 education (p = n.s.) but only 13 (26%) were employed (p = n.s.). The CD4 count of the HIV infected patients were not low, despite several of them not being on ARV drugs. The CP risk factors are compared between the groups in Table 2. Table 2: Risk Factors Whole group HIV positive HIV negative HIV positive vs HIV negative N= 64 N =22 N =42 p-value Ever smoker 56 17 39 0.284 Pack years [Median(Range)] 14 (5-27.5) 12.5 (5-25) 15 (5-27.5) 0.079 Alcohol use 61 21 40 0.46 Petrochemical exposure 32 10 22 0.51 None of the risk factors differed statistically between the groups, although HIV infected patients tended to be heavier smokers (p = 0.079). The clinical aspects of CP are depicted in Table 3. Table 3: Chronic pancreatitis history Whole group HIV positive HIV negative HIV positive vs HIV negative N= 64 N =22 N =42 p-value Years with CP [Median(Range)] 1(1-23) 1(1-23) 2(1-18) 0.363 Exocrine dysfunction 42 14 28 0.785 Units Creon per meal [Median(Range)] 25000 (25000-75000) 40000 (25000-75000) 25000 (25000-50000) 0.019 Endocrine dysfunction 26 4 22 0.033 Insulin use 17 2 15 0.014 HbA1c 6.8 (3.5-12.3) 5.6 (4.5-8.5) 7.21 (3.5-12.3) 0.025 Albumin [Mean(Range)] 36(14-46) 34(14-43) 37(18-46) 0.053 HIV infected patients had a longer CP history. The effect of CP on the patients’ wellbeing did not differ, the groups having similar ECOG scores. The HIV infected patients required more oral pancreas enzyme replacement to control steatorrhea although the proportion with exocrine function did not differ. Significantly more HIV uninfected patients were diabetic (p = 0.033) and required insulin (p = 0.014). Discussion The epidemiology of CP has not been as well defined as other pancreatic diseases. Some population based studies have been reported and these are mostly from developed countries. Incidences differ from 4 cases per 100 000 in the UK6 to 13.4 per 100 000 in Finland. 7 A study from the United States of America reported an age and sex adjusted incidence of 4.5 cases per 100 000 person years. 1 The incidence of CP in Japan has been reported as 11.9 per 100 0008 and 4.2 per 100 000 per year for early CP. 9 No epidemiological studies on CP in Africa have been reported and specifically none from Sub-Saharan Africa which has the greatest incidence of HIV infection in the world. The incidence of CP in patients with HIV infection is not known. A single case report of CP in an HIV patient has been published. 10 An MRI/MRCP study has been published describing only radiological findings of the pancreas in 31 patients with HIV. Sixteen had ductal dilatation but none demonstrated pancreatic calcifications. 11 A pre-HAART era autopsy study of 749 HIV infected patients documented a pathology in 33.9% of pancreas. These were mostly opportunistic infections. 12 No cases of CP were seen. Another autopsy study of 109 AIDS patients, also revealed no cases with features of CP. 13 In the HAART era similar autopsy findings have been reported. 14 CP seems to be rare in HIV infected patients. South Africa has the highest incidence of HIV infection in the world. Nineteen percent of adults between 15 and 49 years of age (7.52 million people) are infected15 , hence it is to be expected that CP would occur in the HIV population. In this study of patients with CP, one third of the study population were found to be HIV infected. The study compared the manifestations of CP in HIV- infected and -uninfected patients. The traditional chronic pancreatitis risk factors did not differ between the groups, of the factors interrogated , alcohol and tobacco use were prominent in both groups. The HIV infected group patients were significantly younger than the HIV uninfected group. The reason for this difference is not discernable from this study. It may be an epiphenomenon in that HIV infection occurs in younger people. It may also be that the progression of pancreatic disease from subclinical to the clinically symptomatic phase is more rapid in HIV infected patients. Subtle and subclinical microscopic exocrine and endocrine pathology occurs in the pancreas of HIV-infected patients16 even in the HAART era. 14 It may be that the development of CP is accelerated in HIV infected patients. The lower incidence of diabetes mellitus (DM) in the HIV infected patients is unexpected. Both a high prevalence of DM and a low prevalence have been reported in HIV infected patients. 17,18 These population-based studies did not interrogate CP in the subjects. The prevalence found was most likely that of type 2 DM, as opposed to type 3c DM which occurs in CP patients. The HIV infected and uninfected patients REVIEW social and dminis- g prevalence of atory drug use in rrhage. Archives of ity associated with emiologic and Eco- orth America.2001; ernal Analgesia,Ati- r Over-the-Counter ister.2009;74(81): w.gpo.gov/fdsys/ ssed on 19 January tial Medicines List for tional Department ble from : www. .pdf [Accessed 19 f prescribed erly patients. British 85-192. n between age- Internal Medi- al. Selective out- nal bleeding in the gy. 1999; 94(5): outh Africa. Statis- ailable from: www. ] on-steroidal anti-in- a risk factor analysis Journal of Gastroen- . Risk for serious e of nonsteroidal nnals of Internal affect risk of non- stroenterology.2013; erienced by AIDS 04; 94(6): 450–454. nagement of HIV linic in Tshwa , 13;14: 94-101. 4) South African Na- viour Survey, 2012 ti-inflammatory for peptic ulcer al of Epidemiology. ntestinal bleeding atment. Drugs astrointestinal dam- erly series : article y.1993; 17: 13-20. Care in South Africa urnal of Medicine. algesics-in-south-af- obacter pylori infec- gs in peptic-ulcer : 14-22. REVIEW