In ART-Treated HIV Patients With GI Discomfort, Consider EPI Assessment

Assessment of pancreatic exocrine function could be considered
Assessment of pancreatic exocrine function could be considered

According to the results of a prospective study, exocrine pancreatic insufficiency (EPI) is prevalent in people living with HIV (PLHIV) who are taking antiretroviral therapy (ART).

Patients included in the study were ≥18 years old, had been taking ART for >6 months, and had a plasma HIV RNA of <50 copies/mL. The study authors explained, “Fecal 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.” Pancreatic enzyme replacement therapy (PERT) was offered to patients with EPI and symptoms and outcomes of this therapy were analyzed. 

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The authors reported, “Of 100 participants, 32% had EPI (fecal elastase-1 <200 μg/g) and 20% severe EPI (fecal elastase-1 <100 μg/g).” Results also showed that there was no correlation between the severity of EPI and self-reported symptoms observed. Of the 32 patients with EPI, 12 began PERT. Of these patients, 75% (9/12) reported being asymptomatic or observing an improvement in symptoms within 14 days.

The study demonstrated that EPI is common in PLHIV who are taking ART. Additionally, no correlation between gastrointestinal symptoms and EPI was observed. The study authors concluded, “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.

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