Frequency of Pancreatic Hyperamylasemia in Human Immunodeficiency Virus–Positive Patients in the Highly Active Antiretroviral Therapy Era

Objectives: Increased frequency of hyperamylasemia has previously been reported in human immunodeficiency virus (HIV)-positive patients, but studies determined total amylase activity and were performed before the introduction of highly active antiretroviral therapy (HAART). We evaluated the frequency of pancreatic hyperamylasemia in a large HIVþ population mostly treated with HAART. Methods: The upper reference limit (URL) for pancreatic amylase (P-AMY) was derived from 299 healthy blood donors. A cross-sectional study was then performed on samples obtained from 1,548 consecutive patients referred to our infectious disease clinic to assess serum P-AMY and lipase concentrations. Of the patients, 94% were HIVþ, and most (92%) were taking HAART (HIVþTxþ). Results: P-AMY URL was 51 U/L. The frequency of P-AMY increase did not significantly differ between HIVþ and HIV - populations (14.2% vs 15.2%, P¼.91) or between HIVþTxþ and HIVþTx - (14.7% vs 8.9%, P¼.11). In almost half (48.3% of HIVþ and 42.9% of HIV -) of hyperamylasemic patients, lipase was normal, indicating a non pancreatic origin of their P-AMY increase. Markedly elevated P-AMY (>3times the URL) was found in six HIVþ patients and in one HIV - patient: two had macroamylasemia, one acute pancreatitis, three (including the HIV - patient) chronic pancreatitis, and one chronic hyperamylasemia of undefined origin. Conclusions: In our study, both HIVþ and HIVþTxþ do not show an increased frequency of P-AMY elevation. Frank pancreatic disease is rare in this clinical setting.