Patterns of pancreatic indices in HIV patients on stavudine, lamivudine and nevirapine

Abstract

In 1984, when my was discovered and subsequently established as the cause of AIDS; the search began to find drugs that could inhibit the replication, growth of this retrovirus, test the safety and efficacy of these drugs in people with the my infection. Zidovudine was one of the first drugs to be tried between 1985 to 1987 and later other drugs came into the market .The greatest shortcoming is from the various individual side effects of the drugs on different organs. Studies being conducted on the side effects of these drugs continue to reveal new side effects that were not observed before. There is limited data on the effects of these drugs in pancreatic function following their use.

The pancreas IS a very important organ for metabolism, yet it can be affected both directly and indirectly by many factors such as drugs, infections and physical agents. ARV drugs are one among many others implicated in the causation of pancreatic insufficiency. The dilemma squarely lies on the absence of data relating to the effects of these drugs on our population. A lot of emphasis is being put on the liver due to its function, yet the pancreas is equally important.

To determine the prevalence of pancreatic function changes in HIV patients both on anti - retroviral and no antiretroviral therapy

A total of 109 patients were recruited into the study, 83 of these were on ARVs while 26 were not on ARV and therefore formed the comparative group. A questionnaire was used at the clinic for the recruitment process. Consent was sought before any specimens were taken. This was a descriptive crossectional study with a comparative arm conducted at Mbagathi and Kenyatta National Hospitals.

Using standard clinical and laboratory methods, all patients attending the HIV clinics in Mbagathi District and Kenyatta national Hospital were recruited. Those who fitted the inclusion criteria and signed consent were recruited into the study. Specimens taken were

used for analysis of alpha amylase, lipase, insulin, CD4 levels and random blood sugar levels (RBS).

The study took one year.

All the results were analyzed at the end of the study as follows: blood glucose - Glucose oxidase method, amylase and lipase-colorimetric method, insulin- immunoassay technique. Appropriate conclusions were made at the end of data collection by the principal investigator.

This study established the association between the uses of ARVs in the HIV infected individuals and the pancreatic indices. The prevalence of an elevated Amylase level is 17% in patients on ARVs while that of an elevated Lipase level is 7%. Hyperamylasemia is a relatively common event in HIV -infected patients with or without ARV use. Hyperlipasemia is a common event in HIV-infected patients with ARV use. Hyperlipasemia could be predictive of pancteatitis in patients on ARVs. The prevalence of an elevated RBS is 7% in patients on ARVs with a positive correlation (p=O.048). The prevalence of elevated Insulin is 16% in patients on ARVs with no significant correlation between the duration of ARV use and the insulin levels There is no significant correlation between the latest CD4 cells and the pancreatic indices.