Patterns of pancreatic indices in HIV patients on stavudine, lamivudine and nevirapine
Abstract
In 1984, when my was discovered and subsequently established as the cause of AIDS;
the search began to find drugs that could inhibit the replication, growth of this retrovirus,
test the safety and efficacy of these drugs in people with the my infection. Zidovudine
was one of the first drugs to be tried between 1985 to 1987 and later other drugs came
into the market .The greatest shortcoming is from the various individual side effects of
the drugs on different organs. Studies being conducted on the side effects of these drugs
continue to reveal new side effects that were not observed before. There is limited data on
the effects of these drugs in pancreatic function following their use.
The pancreas IS a very important organ for metabolism, yet it can be affected both
directly and indirectly by many factors such as drugs, infections and physical agents.
ARV drugs are one among many others implicated in the causation of pancreatic
insufficiency. The dilemma squarely lies on the absence of data relating to the effects of
these drugs on our population. A lot of emphasis is being put on the liver due to its
function, yet the pancreas is equally important.
To determine the prevalence of pancreatic function changes in HIV patients both on anti -
retroviral and no antiretroviral therapy
A total of 109 patients were recruited into the study, 83 of these were on ARVs while 26
were not on ARV and therefore formed the comparative group. A questionnaire was used
at the clinic for the recruitment process. Consent was sought before any specimens were
taken.
This was a descriptive crossectional study with a comparative arm conducted at Mbagathi
and Kenyatta National Hospitals.
Using standard clinical and laboratory methods, all patients attending the HIV clinics in
Mbagathi District and Kenyatta national Hospital were recruited. Those who fitted the
inclusion criteria and signed consent were recruited into the study. Specimens taken were
used for analysis of alpha amylase, lipase, insulin, CD4 levels and random blood sugar
levels (RBS).
The study took one year.
All the results were analyzed at the end of the study as follows: blood glucose - Glucose
oxidase method, amylase and lipase-colorimetric method, insulin- immunoassay
technique. Appropriate conclusions were made at the end of data collection by the
principal investigator.
This study established the association between the uses of ARVs in the HIV infected
individuals and the pancreatic indices. The prevalence of an elevated Amylase level is
17% in patients on ARVs while that of an elevated Lipase level is 7%. Hyperamylasemia
is a relatively common event in HIV -infected patients with or without ARV use.
Hyperlipasemia is a common event in HIV-infected patients with ARV use.
Hyperlipasemia could be predictive of pancteatitis in patients on ARVs. The prevalence
of an elevated RBS is 7% in patients on ARVs with a positive correlation (p=O.048). The
prevalence of elevated Insulin is 16% in patients on ARVs with no significant correlation
between the duration of ARV use and the insulin levels There is no significant
correlation between the latest CD4 cells and the pancreatic indices.
Citation
Masters of Medicine (Human Pathology)Publisher
University of Nairobi School of Medicine