Abnormalities of Serum Amylase and Lipase in HIV-Positive Patients Athanassios Argiris, M.D., Usha Mathur-Wagh, M.D., Ilene Wilets, Ph.D., and Donna Mildvan, M.D. Department of Internal Medicine, Division of Infectious Diseases, Beth Israel Medical Center, New York, New York OBJECTIVE: We sought to study asymptomatic pancreatic enzyme abnormalities in patients with human immunodefi- ciency virus (HIV) infection. METHODS: Serial serum amylase and lipase determinations were performed in ambulatory HIV-seropositive patients in whom pancreatitis was not suspected. RESULTS: Eighty-six patients were enrolled in the study. Fifty-two patients (60%) were found to have abnormal amy- lase or lipase values on at least one determination. Only 12 (14% of all patients) had a more than twofold elevation of pancreatic enzymes. Seven patients had transient elevations of lipase within 3 months after the initiation of antiretroviral therapy. Independent factors associated with abnormal pan- creatic enzymes were: positive serology for chronic hepa- titis B or C, history of intravenous cotrimoxazole adminis- tration for the treatment of Pneumocystis carinii pneumonia, stage B of HIV disease, and HIV risk factors other than male homosexuality (mainly intravenous drug use). None of the patients developed clinical pancreatitis. CONCLUSIONS: Asymptomatic mild to moderate elevations of amylase or lipase are common in HIV-positive patients, and are usually associated with positive serology for chronic hepatitis B or C, and medications, especially antiretrovirals and intravenous cotrimoxazole. (Am J Gastroenterol 1999; 94:1248 –1252. © 1999 by Am. Coll. of Gastroenterology) INTRODUCTION Pancreatic lesions, due to opportunistic infections or neo- plasms, but more often nonspecific, can be found in 50% of patients with acquired immunodeficiency syndrome (AIDS) at autopsy (1–3). Clinically significant pancreatic involvement is rarely seen antemortem. However, the de- velopment of acute pancreatitis has been increasingly rec- ognized in human immunodeficiency virus (HIV)-positive patients in recent years (1– 4). In addition to symptomatic elevations of pancreatic enzymes, there have been reports of unexplained serum amylase elevations, sometimes with concomitant lipase elevations, without clinical evidence of pancreatitis (5). Hyperamylasemia in HIV-positive patients can be due to pancreatic pathology, usually pancreatitis, or extrapancreatic causes, such as other gastrointestinal dis- eases, renal failure, acidemia, macroamylasemia, and pa- rotid gland disease (3, 4). We initiated a study aimed at evaluating amylase and lipase elevations in HIV-positive patients. Our goal was to determine the frequency of asymptomatic pancreatic en- zyme elevations in a cohort of HIV-positive patients in an ambulatory setting and to associate it with potential caus- ative factors. PATIENTS AND METHODS Eligible subjects required documentation of a positive HIV serology and were enrolled as consecutive encounters by the physicians involved in the study in the Peter Krueger Clinic of Immunological Disorders at Beth Israel Medical Center, New York. The protocol of the study was approved by the institutional review board. Patients  age 18 yr as well as patients with a history of pancreatitis were excluded from the study. History of HIV risk factors, opportunistic infec- tions, medications, and other concomitant illnesses was ob- tained. All patients were categorized according to the clas- sification system of the Centers for Disease Control (1993 revised) (6). Serum amylase and lipase concentrations were measured by an automated enzymatic colorimetric assay in the routine chemistry laboratory. The normal range of val- ues for amylase was 25–125 U/L and for lipase, 10 –70 U/L. In addition, CD4+ T-lymphocyte counts and biochemical profiles, which included measurements of serum transami- nase, globulin, and creatinine concentrations, were per- formed in most patients. Serological markers for hepatitis B and hepatitis C were available in the majority of patients. Patients positive for hepatitis B surface antigen and hepatitis B core IgG antibodies were considered to have chronic hepatitis B. Pancreatic enzymes were initially tested at en- rollment and subsequently at 1 to 2-month intervals. The categorical variables were compared between groups using the  2 test or the Fisher’s exact test and the mean value of the continuous variables was compared between groups using the t test. Logistic regression analysis was performed using the Statistical Package for Social Sciences for Win- dows, release 6.1 (SPSS Inc., Chicago, IL). Within a logistic regression model, with backward stepwise selection, vari- THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 94, No. 5, 1999 © 1999 by Am. Coll. of Gastroenterology ISSN 0002-9270/99/$20.00 Published by Elsevier Science Inc. PII S0002-9270(99)00130-6