Skip to main content
PMC home page
Gut logoLink to Gut
. 1998 Oct;43(4):558–563. doi: 10.1136/gut.43.4.558

Pancreatic dysfunction and its association with fat malabsorption in HIV infected children

A Carroccio 1, M Fontana 1, M Spagnuolo 1, G Zuin 1, G Montalto 1, R Canani 1, F Verghi 1, M Di 1, K Bastoni 1, F Buffardi 1, A Guarino 1
PMCID: PMC1727265  PMID: 9824586

Abstract

Background—Nutrient malabsorption frequently occurs in HIV infected children, but very few studies have investigated exocrine pancreatic digestive capacity in these cases. 
Aims—To investigate pancreatic function in HIV infected children and to determine whether faecal fat loss, a prominent feature of intestinal dysfunction, is associated with pancreatic dysfunction. 
Patients—Forty seven children with HIV infection without apparent pancreatic disease and 45 sex and age matched healthy controls. 
Methods—Pancreatic function was evaluated by measuring elastase 1 concentration and chymotrypsin activity in stools by ELISA and colorimetric methods, respectively. Intestinal function was evaluated by measuring fat and protein loss by the steatocrit method and by faecal α1 antitrypsin concentration. 
Results—14 (30%) had abnormal pancreatic function tests: seven had isolated elastase activity deficiency, three isolated chymotrypsin deficiency, and four pancreatic deficiencies in both enzymes. Patient enzyme values were significantly lower than those of controls. Low faecal pancreatic enzymes were not associated with symptoms. Twelve children had steatorrhoea and four had increased α1 antitrypsin. Steatorrhoea was significantly associated with reduced faecal pancreatic enzymes. There was a significant negative correlation between elastase 1 concentration and steatocrit. Children with pathological faecal elastase 1 or chymotrypsin values did not differ from the other HIV infected children with respect to nutritional and immunological status, stage of HIV disease, presence of opportunistic infections, or drug administration. 
Conclusions—Abnormal pancreatic function tests are a frequent feature of paediatric HIV infection; this condition is associated with steatorrhoea, which probably contributes to the disease. 



Keywords: HIV; children; pancreas; steatorrhea; malnutrition; intestine

Full Text

The Full Text of this article is available as a PDF (145.8 KB).

Figure 1 .

Figure 1

Open in a new tab

Individual and mean values of faecal chymotrypsin activity. Dotted line indicates lower normal limit. Bars indicate mean values and 95% confidence intervals. 


Figure 2 .

Figure 2

Open in a new tab

Individual and mean values of faecal elastase 1. Dotted line indicates lower normal limit. Bars indicate mean values and 95% confidence intervals. 


Figure 3 .

Figure 3

Open in a new tab

Relation between faecal fat content and pancreatic deficiency (reduced faecal CMT and/or EL-1 activities) in HIV infected patients. 


Figure 4 .

Figure 4

Open in a new tab

Regression analysis of faecal elastase 1 and steatocrit values in HIV infected patients. 


Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bricaire F., Marche C., Zoubi D., Saimot A. G., Regnier B. HIV and the pancreas. Lancet. 1988 Jan 2;1(8575-6):65–66. doi: 10.1016/s0140-6736(88)91052-5. [DOI] [PubMed] [Google Scholar]
  2. Brivet F., Coffin B., Bedossa P., Naveau S., Petitpretz P., Delfraissy J. F., Dormont J. Pancreatic lesions in AIDS. Lancet. 1987 Sep 5;2(8558):570–571. doi: 10.1016/s0140-6736(87)92956-4. [DOI] [PubMed] [Google Scholar]
  3. Cappell M. S., Hassan T. Pancreatic disease in AIDS--a review. J Clin Gastroenterol. 1993 Oct;17(3):254–263. doi: 10.1097/00004836-199310000-00017. [DOI] [PubMed] [Google Scholar]
  4. Carroccio A., Iacono G., Lerro P., Cavataio F., Malorgio E., Soresi M., Baldassarre M., Notarbartolo A., Ansaldi N., Montalto G. Role of pancreatic impairment in growth recovery during gluten-free diet in childhood celiac disease. Gastroenterology. 1997 Jun;112(6):1839–1844. doi: 10.1053/gast.1997.v112.pm9178674. [DOI] [PubMed] [Google Scholar]
  5. Carroccio A., Iacono G., Montalto G., Cavataio F., Di Marco C., Balsamo V., Notarbartolo A. Exocrine pancreatic function in children with coeliac disease before and after a gluten free diet. Gut. 1991 Jul;32(7):796–799. doi: 10.1136/gut.32.7.796. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Carroccio A., Iacono G., Montalto G., Cavataio F., Lorello D., Greco L., Soresi M., Notarbartolo A. Pancreatic enzyme therapy in childhood celiac disease. A double-blind prospective randomized study. Dig Dis Sci. 1995 Dec;40(12):2555–2560. doi: 10.1007/BF02220441. [DOI] [PubMed] [Google Scholar]
  7. Castaldo A., Tarallo L., Palomba E., Albano F., Russo S., Zuin G., Buffardi F., Guarino A. Iron deficiency and intestinal malabsorption in HIV disease. J Pediatr Gastroenterol Nutr. 1996 May;22(4):359–363. doi: 10.1097/00005176-199605000-00004. [DOI] [PubMed] [Google Scholar]
  8. Catassi C., Cardinali E., D'Angelo G., Coppa G. V., Giorgi P. L. Reliability of random fecal alpha 1-antitrypsin determination on nondried stools. J Pediatr. 1986 Sep;109(3):500–502. doi: 10.1016/s0022-3476(86)80128-7. [DOI] [PubMed] [Google Scholar]
  9. Craig R. M., Atkinson A. J., Jr D-xylose testing: a review. Gastroenterology. 1988 Jul;95(1):223–231. doi: 10.1016/0016-5085(88)90318-6. [DOI] [PubMed] [Google Scholar]
  10. Guarino A., Tarallo L., Greco L., Cesarano L., Guandalini S., Rubino A. Reference values of the steatocrit and its modifications in diarrheal diseases. J Pediatr Gastroenterol Nutr. 1992 Apr;14(3):268–274. doi: 10.1097/00005176-199204000-00006. [DOI] [PubMed] [Google Scholar]
  11. Guarino A., Tarallo L., Guandalini S., Troncone R., Albano F., Rubino A. Impaired intestinal function in symptomatic HIV infection. J Pediatr Gastroenterol Nutr. 1991 May;12(4):453–458. doi: 10.1097/00005176-199105000-00007. [DOI] [PubMed] [Google Scholar]
  12. HIV and the pancreas. Lancet. 1987 Nov 21;2(8569):1212–1213. [PubMed] [Google Scholar]
  13. HIV and the pancreas. Lancet. 1987 Nov 21;2(8569):1212–1213. [PubMed] [Google Scholar]
  14. Intestinal malabsorption of HIV-infected children: relationship to diarrhoea, failure to thrive, enteric micro-organisms and immune impairment. The Italian Paediatric Intestinal/HIV Study Group. AIDS. 1993 Nov;7(11):1435–1440. [PubMed] [Google Scholar]
  15. Kahn E., Anderson V. M., Greco M. A., Magid M. Pancreatic disorders in pediatric acquired immune deficiency syndrome. Hum Pathol. 1995 Jul;26(7):765–770. doi: 10.1016/0046-8177(95)90225-2. [DOI] [PubMed] [Google Scholar]
  16. Kapembwa M. S., Fleming S. C., Griffin G. E., Caun K., Pinching A. J., Harris J. R. Fat absorption and exocrine pancreatic function in human immunodeficiency virus infection. Q J Med. 1990 Jan;74(273):49–56. [PubMed] [Google Scholar]
  17. Keating J., Bjarnason I., Somasundaram S., Macpherson A., Francis N., Price A. B., Sharpstone D., Smithson J., Menzies I. S., Gazzard B. G. Intestinal absorptive capacity, intestinal permeability and jejunal histology in HIV and their relation to diarrhoea. Gut. 1995 Nov;37(5):623–629. doi: 10.1136/gut.37.5.623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Löser C., Möllgaard A., Fölsch U. R. Faecal elastase 1: a novel, highly sensitive, and specific tubeless pancreatic function test. Gut. 1996 Oct;39(4):580–586. doi: 10.1136/gut.39.4.580. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Miller T. L., Orav E. J., Martin S. R., Cooper E. R., McIntosh K., Winter H. S. Malnutrition and carbohydrate malabsorption in children with vertically transmitted human immunodeficiency virus 1 infection. Gastroenterology. 1991 May;100(5 Pt 1):1296–1302. [PubMed] [Google Scholar]
  20. Miller T. L., Winter H. S., Luginbuhl L. M., Orav E. J., McIntosh K. Pancreatitis in pediatric human immunodeficiency virus infection. J Pediatr. 1992 Feb;120(2 Pt 1):223–227. doi: 10.1016/s0022-3476(05)80431-7. [DOI] [PubMed] [Google Scholar]
  21. Sharpstone D., Gazzard B. Gastrointestinal manifestations of HIV infection. Lancet. 1996 Aug 10;348(9024):379–383. doi: 10.1016/S0140-6736(96)01034-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Stein J., Jung M., Sziegoleit A., Zeuzem S., Caspary W. F., Lembcke B. Immunoreactive elastase I: clinical evaluation of a new noninvasive test of pancreatic function. Clin Chem. 1996 Feb;42(2):222–226. [PubMed] [Google Scholar]
  23. Wilcox C. M., Forsmark C. E., Grendell J. H., Darragh T. M., Cello J. P. Cytomegalovirus-associated acute pancreatic disease in patients with acquired immunodeficiency syndrome. Report of two patients. Gastroenterology. 1990 Jul;99(1):263–267. doi: 10.1016/0016-5085(90)91257-7. [DOI] [PubMed] [Google Scholar]
  24. Yolken R. H., Hart W., Oung I., Shiff C., Greenson J., Perman J. A. Gastrointestinal dysfunction and disaccharide intolerance in children infected with human immunodeficiency virus. J Pediatr. 1991 Mar;118(3):359–363. doi: 10.1016/s0022-3476(05)82147-x. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES