ВИЧ-АССОЦИИРОВАННЫЙ ПАНКРЕАТИТ. ПРИЧИНЫ И ТЕНДЕНЦИИ. АНАЛИЗ СЕРИИ СЛУЧАЕВ

Abstract

Introduction. Acute pancreatitis is common in HIV-infected patients and has a number of significant features that directly affect the methods of diagnosis and treatment. Aim. To study risk factors of acute pancreatitis development in patients with HIV-infection with immunosuppressive disorders and to determine treatment and diagnostic algorithm in this group of patients. Material and Methods. Anamnestic data, results of diagnosis and treatment of two groups of patients with acute pancreatitis were analyzed. The first group included 79 patients with acute pancreatitis combined with HIV infection who were admitted to the clinic for the period from 2017 to 2021. The second group consisted of 558 HIV-negative patients with acute pancreatitis. Results and discussion. In the group of HIV-positive patients it turned out that alimentary factors caused pancreatitis in 31,7% of patients, biliary concretions and hypertension in 16,5% of patients, it was not possible to establish an initiating factor of the disease in 16,5% of cases. In people living with HIV drugs and infectious agents caused acute pancreatitis in 11,4% and 24,1% of cases respectively. Alimentary factors were in the lead in the group of HIV–negative patients (52,2%), gallstone disease was considered as the second main cause of pancreatitis – 36,0% of cases, viral infections and the consequences of the use of drugs respectively accounted for 1,6%, and in 10,2% of patients the cause of acute pancreatitis remained unknown. Discussion. As our study showed, in patients with normal immune status the drug etiology of pancreatitis prevailed in the structure of the causes of pancreatitis, in patients with immunodeficiency, respectively, infectious causes of pancreatitis were dominant. Based on the obtained data on the cause of pancreatitis, the rational therapeutic and diagnostic algorithm was formed, the use of which in clinical practice will allow timely initiation of etiotropic and pathogenetic therapy in a group of HIV- positive patients. Conclusion. The etiological structure of HIV-associated acute pancreatitis directly depends on the patient’s immune status and differs in many ways from that of HIV-negative patients or patients receiving antiretroviral therapy. The severity of the disease and the risk of death remain high in acute pancreatitis caused by infectious agents against the background of immunosuppression.