Exocrine pancreatic insufficiency is common in people living with HIV on effective antiretroviral therapy

Abstract

Objectives: The primary aim of this prospective study was to determine the prevalence of exocrine pancreatic insufficiency (EPI) in people living with HIV (PLHIV) on suppressive antiretroviral therapy (ART).

Methods: PLHIV ≥18 years of age and on ART for >6 months and with HIV RNA <50 copies/mL plasma were included. Faecal elastase-1 measurement was performed on a single stool sample, serum markers of malnutrition were collected, and participants answered a short questionnaire about gastrointestinal symptoms. Participants with EPI and symptoms were offered pancreatic enzyme replacement therapy (PERT), and the result of this therapy was also evaluated.

Results: Of 100 participants, 32% had EPI (faecal elastase-1 < 200 μg/g) and 20% severe EPI (faecal elastase-1 < 100 μg/g). We did not find any correlation between self-reported symptoms and degree of EPI. Twelve out of the 32 participants with EPI accepted to start PERT. Nine out of 12 (75%) reported improvement or became asymptomatic within 14 days.

Conclusion: EPI is common in PLHIV on effective ART. We could, however, not find a correlation between gastrointestinal symptoms and the presence of EPI. Assessment of pancreatic exocrine function could be considered in PLHIV particularly in those with gastrointestinal discomfort, since there is a possible gain in treating them with relief of symptoms and improved quality of life. The effects of PERT in PLHIV on effective ART need further study.

Keywords:

• HIV
• Antiretroviral therapy
• Exocrine pancreatic insufficiency

Acknowledgements

We are thankful to all participants.

Disclosure of interest

The authors no conflicts of interests.

Ethics approval and consent to participate

The study was approved by the Ethics Committee in Gothenburg (Dnr: 781-14).

Participants were given oral and written information about the study and gave their consent to participate.

Additional information

Funding

This work was supported by the Sahlgrenska University Hospital [ALFGBG-430271]. Mylan provided the fecal-1 elastase measurements.