One thousand and eighty-one evaluable HIV-infected patients were assessed for pancreatic abnormalities in a prospective case-control study including the whole follow-up period of each patient (minimum 12 months). The 435 patients (40.2%), who experienced at least one episode of confirmed pancreatic laboratory abnormality had a longer duration of seropositivity, exposure to
protease inhibitors, a more frequent immunodeficiency,
AIDS, chronic liver and/or biliary disease and hypertriglyceridaemia, while no relation was found with antiretroviral administration, and the duration of type of
nucleoside analogues, when compared with the 646 controls. High and prolonged laboratory alterations eventually associated with signs of organ involvement occurred in 166 cases (38.2%), and were related to the administration of
didanosine,
stavudine,
lamivudine,
pentamidine,
cotrimoxazole or antitubercular/antimycobacterial
therapy, cytotoxic
chemotherapy, illicit substance or
alcohol abuse,
opportunistic infections, chronic liver and/or biliary disease, a
protease inhibitor-based
highly active antiretroviral therapy (
HAART) and hypertriglyceridaemia (usually associated with
HAART administration). No difference was noticed between the 46 patients with clinical and/or imaging evidence of pancreatic involvement and the 120 asymptomatic subjects. Although recurrences of
enzyme alterations involved 69.6% of patients, only in 30.1% of cases did a change of the underlying antiretroviral or antimicrobial
therapy become necessary. An acute, uncomplicated
pancreatitis occurred in nine of the 46 symptomatic subjects (19.6%). A two to four week
gabexate and/or
octreotide administration (performed in 79 cases of 166, 47.6%), achieved a significant laboratory, clinical and imaging cure or improvement in 82.3% of cases, with a better success rate of combined (
gabexate mesilate plus
octreotide) vs. single (
gabexate mesilate or ocreotide)
therapy. Reduced disease recurrences and a better tolerability of antiretroviral regimens, were also noticed.