Efficacy of oral pancreatic enzyme therapy for the treatment of fat malabsorption in HIV‐infected patients

Background: Nutrient malabsorption is a negative prognostic factor in acquired immunodeficiency syndrome and recent studies have shown that pancreatic insufficiency is a codetermining factor of malabsorption. Aims: To evaluate the effectiveness of open‐label oral pancreatic enzyme supplementation therapy in acquired immunodeficiency syndrome patients with fat malabsorption. Patients and methods: Twenty‐four consecutive patients with human immunodeficiency virus infection and fat malabsorption were recruited (11 males, 13 females; median age, 9.1 years). Faecal fat loss was evaluated by steatocrit assay at entry to the study (T‐0), after 2 weeks (T‐1) without pancreatic enzyme treatment and after a further 2 weeks (T‐2) of treatment with pancreatic extracts (Creon 10 000 at a dose of 1000 units of lipase per gram of ingested dietary fat). Faecal elastase‐1 and chymotrypsin were assayed at entry. Results: Six patients (25%) had abnormally low elastase‐1 and/or chymotrypsin faecal concentration. In all patients, steatocrit values were elevated at both T‐0 and T‐1. Five patients proved intolerant to pancreatic enzyme treatment because of the onset of abdominal pain, and therapy was discontinued. In the 19 patients who concluded the study, steatocrit values during pancreatic enzyme treatment (T‐2) were significantly lower than at entry (P