The prevalence of acute pancreatitis in HIV positive medical in-patients presenting at Kenyatta National Hospital (KNH) with acute upper abdominal pain

Abstract

Background: AP is an inflammatory disease of the pancreas with variable involvement of remote organ systems. There are various theories put forward to explain the pathogenesisof acute pancreatitis, which remains unclear. Acute onset of upper abdominal pain makes one suspect acute pancreatitis. With the HIV pandemic, acute pancreatitis has been noted to be on the increase, due mainly to opportunistic infections, malnutrition and drug therapy used in HIV. Acute pancreatitisis potentially treatable if recognized early, but if diagnosis is delayed, it can be life threatening and it has a negative impact on HIV prognosis. Local published data on HIV associated acute pancreatitis are lacking and so this study has shed light on this important subject. Objectives: To determine the prevalence of acute pancreatitis in HIV positive patients presenting with features of acute abdominal pain at Kenyatta National Hospital and correlate the presence of acute pancreatitis with extent of HIV disease and the presence of other evident acute pancreatitis risk factors. Design: Cross sectional survey. Setting: Medical and surgical wards of Kenyatta National Hospital, a tertiary referral hospital in Nairobi, Kenya. Methods: Pretest counselling for HIV testing was undertaken in all consecutive patients with complaints of upper abdominal pain and in those who consented, the test was done. Those that tested positive for HIV by the Rapid HIV 1 and 2 assays were recruited into the study. They underwent a clinical examination and venous blood was drawn for serum amylase, lipase and CD4 lymphocyte count analysis. A case of acute pancreatitis was defined as a patient with acute upper abdominal pain of less than seven days duration with serum amylase and lor lipase levels higher than theupperreference limit of the assay method used. Results: The prevalence of HIV positivity in patients admitted with acute abdominal painwas 45.1%, and the prevalence of AP in those testing positive for HIV was 29.9%, basedon serum amylase levels >125 u/l and/or serum lipase levels above 78 u/l. There was no significant difference in the clinical presentation in those with or without AP. However,patients reporting relief of pain with milk and food were unlikely to have AP (p value 0.02). There was no correlation between presence of acute pancreatitis and extent of HIV disease as depicted by CD4 counts. The presence of opportunistic infections, for example candidiasis and herpes zoster, as evident risk factors for AP did not differ between those with and without AP. Conclusions: There was no statistically significant difference in the age, sex, mode of presentation, presence of opportunistic infections and CD4 counts in those with and without AP. Recommendations: AP should be looked for in HIV positive patients with acute abdominal pain. Further research is required to identify causes of AP in HIV positive patients in our setup and to determine the patient's clinical outcomes.