Disorders of the Pancreas

Part of the Clinical Gastroenterology book series (CG)


Although the human immunodeficiency virus (HIV) has not been isolated in pancreatic tissue (Bennett et al. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Elsevier/Saunders, Philadelphia, 2015), infections and inflammatory conditions of the pancreas are common during the course of acquired immunodeficiency syndrome (AIDS) and contribute significantly to its associated morbidity and mortality. HIV infection itself has been associated with an increased risk of clinical pancreatitis, but specific etiologies are broad. These include antiretroviral medications, chemoprophylaxis drugs for opportunistic infections, malignancy, and the virus itself. Similarly, bacterial, viral, fungal, and mycobacterial pathogens can contribute to the acute pancreatic inflammatory conditions. The pancreas can serve as the primary nidus of infection or ultimately be involved after dissemination of opportunistic infections. In addition, one must consider etiologies that are seen in the general population such as gallstones and complications of alcohol and intravenous drug abuse.


HIV/AIDS Pancreas Pancreatitis Drug-Induced Pancreatitis Pancreatic abscess 


  1. 1.
    Lack EE. Infectious, parasitic, and other disorders of the pancreas. In: Pathology of the pancreas, gallbladder, extrahepatic biliary tract, and ampullary region. New York: Oxford University Press; 2003. p. 118–9.Google Scholar
  2. 2.
    Bennett JE, Dolin R, Blaser MJ. Pancreatic infections. In: Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Philadelphia: Elsevier/Saunders; 2015. p. 969.Google Scholar
  3. 3.
    Bitar A, Altaf M, Sferra TJ. Acute pancreatitis: manifestation of acute HIV infection in an adolescent. Am J Case Rep. 2012;13:17–8.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Rizzardi GP, Tambussi G, Lazzarin A. Acute pancreatitis during primary HIV-1 infection. N Engl J Med. 1997;336:1836–7.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Cuenca Carvajal C, Ortiz Vega M, Gómez Antúnez M, Pérez Tamayo I, Filgueira Rubio JS. Acute pancreatitis complicating primary HIV-1 infection. An Med Interna. 1998;15:324–6.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Sinicco A, Sciandra M, Di Garbo A, Bertone C, Contuzzi E, Raiteri R. Primary HIV infection presenting with acute pancreatitis. Scand J Infect Dis. 1999;31:423–4.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Mortier E, Gaba S, Mari I, Vinceneux P, Pouchot J. Acute pancreatitis during primary HIV-1 infection. Am J Gastroenterol. 2002;97:504–7.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Tyner R, Turett G. Primary human immunodeficiency virus infection presenting as acute pancreatitis. South Med J. 2004;97:393–4.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Sah RP, Garg P, Saluja AK. Pathogenic mechanisms of acute pancreatitis. Curr Opin Gastroenterol. 2012;28:507–15.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Oliveira NM, Ferreira FAY, Yonamine RY, Chehter EZ. Antiretroviral drugs and acute pancreatitis in HIV/AIDS patients: is there any association? A literature review. Einstein (Sao Paulo). 2014;12:112–9.CrossRefGoogle Scholar
  11. 11.
    Riedel DJ, Gebo KA, Moore RD, Lucas GM. A ten-year analysis of the incidence and risk factors for acute pancreatitis requiring hospitalization in an urban HIV clinical cohort. AIDS Patient Care STDs. 2008;22:113–21.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Manfredi R, Calza L, Chiodo F. A case-control study of HIV-associated pancreatic abnormalities during HAART era. Focus on emerging risk factors and specific management. Eur J Med Res. 2004;9:537–44.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Reisler RB, Murphy RL, Redfield RR, Parker R. Incidence of pancreatitis in HIV-1-infected individuals enrolled in 20 adult AIDS clinical trials group studies: lessons learned. J Acquir Immune Defic Syndr. 2005;39:159–66.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Hung WY, Abreu Lanfranco O. Contemporary review of drug-induced pancreatitis: a different perspective. World J Gastrointest Pathophysiol. 2014;5:405–15.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Brinkman K, ter Hofstede HJ, Burger DM, Smeitink JA, Koopmans PP. Adverse effects of reverse transcriptase inhibitors: mitochondrial toxicity as common pathway. AIDS. 1998;12(14):1735–44. Gower Academic Journals.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Koczor CA, Lewis W. Nucleoside reverse transcriptase inhibitor toxicity and mitochondrial DNA. Expert Opin Drug Metab Toxicol. 2010;6(12):1493–504.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Aboulafia DM. Acute pancreatitis. A fatal complication of AIDS therapy. J Clin Gastroenterol. 1997;25:640–5.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Fulco PP, Kirian MA. Effect of tenofovir on didanosine absorption in patients with HIV. Ann Pharmacother. 2003;37(9):1325–8.CrossRefGoogle Scholar
  19. 19.
    Martínez E, Milinkovic A, de Lazzari E, Ravasi G, José LB, Larrousse M, Mallolas J, García F, Miró JM, Gatell JM. Pancreatic toxic effects associated with co-administration of didanosine and tenofovir in HIV-infected adults. Lancet. 2004;364:65–7.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Patel MK, Barvaliya MJ, Patel TK, Tripathi CB. Stavudine induced acute necrotizing pancreatitis with tetany in a pediatric patient. Indian J Pharmacol. 2012;44:523–5.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Maskew M, Westreich D, Fox MP, Maotoe T, Sanne IM. Effectiveness and safety of 30 mg versus 40 mg stavudine regimens: a cohort study among HIV-infected adults initiating HAART in South Africa. J Int AIDS Soc. 2012;15:13.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Pujades-Rodríguez M, Dantony E, Pinoges L, Ecochard R, Etard J-F, Carrillo-Casas E, Szumilin E, AIDS Working Group of Médecins Sans Frontières. Toxicity associated with Stavudine dose reduction from 40 to 30 mg in first-line antiretroviral therapy. PLoS One. 2011;6:e28112.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Kakuda TN. Pharmacology of nucleoside and nucleotide reverse transcriptase inhibitor-induced mitochondrial toxicity. Clin Ther. 2000;22:685–708.PubMedCrossRefGoogle Scholar
  24. 24.
    Sullivan AK, Feher MD, Nelson MR, Gazzard BG. Marked hypertriglyceridaemia associated with ritonavir therapy. AIDS. 1998;12:1393–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Mirete G, Masiá M, Gutiérrez F, Mora A, Escolano C, Maestre A. Acute pancreatitis as a complication of ritonavir therapy in a patient with AIDS. Eur J Clin Microbiol Infect Dis. 1998;17:810–1.PubMedCrossRefGoogle Scholar
  26. 26.
    Chapman SJ, Woolley IJ, Visvanathan K, Korman TM. Acute pancreatitis caused by tipranavir/ritonavir-induced hypertriglyceridaemia. AIDS. 2007;21:532–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Perry RC, Cushing HE, Deeg MA, Prince MJ. Ritonavir, triglycerides, and pancreatitis. Clin Infect Dis. 1999;28:161–2.PubMedCrossRefGoogle Scholar
  28. 28.
    Routy J-P, Smith GHR, Blank DW, Gilfix BM. Plasmapheresis in the treatment of an acute pancreatitis due to protease inhibitor-induced hypertriglyceridemia. J Clin Apher. 2001;16:157–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Markowitz M, Saag M, Powderly WG, et al. A preliminary study of ritonavir, an inhibitor of HIV-1 protease, to treat HIV-1 infection. N Engl J Med. 1995;333:1534–40.PubMedCrossRefGoogle Scholar
  30. 30.
    Saharia P, Margolis S, Zuidema GD, Cameron JL. Acute pancreatitis with hyperlipemia: studies with an isolated perfused canine pancreas. Surgery. 1977;82:60–7.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Sun HY, Chang SY, Sheng WH, et al. Incidence of acute pancreatitis in human immunodeficiency virus–positive patients with hypertriglyceridemia. Pancreas. 2012;41:283–9.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Kaurich T. Drug-induced acute pancreatitis. Proc (Bayl Univ Med Cent). 2008;21(1):77–81.CrossRefGoogle Scholar
  33. 33.
    Bush ZM, Kosmiski LA. Acute pancreatitis in HIV-infected patients: are etiologies changing since the introduction of protease inhibitor therapy? Pancreas. 2003;27:e1–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Trivedi CD, Pitchumoni CS. Drug-induced pancreatitis: an update. J Clin Gastroenterol. 2005;39:709. Scholar
  35. 35.
    Pauwels MA, Eliaszewicz CM, Larrey CD, Lacassin CF, Poirier CJ, Meyohas CM, Frottier C. Pentamidine-induced acute pancreatitis in a patient with AIDS. J Clin Gastroenterol. 1990;12(4):457–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Murphy RL, Noskin GA, Ehrenpreis ED. Acute pancreatitis associated with aerosolized pentamidine. Am J Med. 1990;88:53N–6N.PubMedCrossRefGoogle Scholar
  37. 37.
    Villamil A, Hammer RA, Rodriguez FH. Edematous pancreatitis associated with intravenous pentamidine. South Med J. 1991;84:796–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Bartels RH, van der Spek JA, Oosten HR. Acute pancreatitis due to sulfamethoxazole-trimethoprim. South Med J. 1992;85(10):1006–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Brett AS, Shaw SV. Simultaneous pancreatitis and hepatitis associated with trimethoprim-sulfamethoxazole. Am J Gastroenterol. 1999;94:267. Scholar
  40. 40.
    Park TY, Oh H-C, Do JH. A case of recurrent pancreatitis induced by trimethoprim-sulfamethoxazole re-exposure. Gut Liver. 2010;4:250–2.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Versleijen MWJ, Naber AHJ, Riksen NP, Wanten GJ, Debruyne FMJ. Recurrent pancreatitis after trimethoprim-sulfamethoxazole rechallenge. Neth J Med. 2005;63(7):275–7.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Floris-Moore MA, Amodio-Groton MI, Catalano MT. Adverse reactions to trimethoprim/sulfamethoxazole in AIDS. Ann Pharmacother. 2003;37:1810–3.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Antonow DR. Acute pancreatitis associated with trimethoprim-sulfamethoxazole. Ann Intern Med. 1986;104:363–5.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    González-Reimers E, Santolaria-Fernádez F, Gómez-sirvent JL, Méndez-Medina R, Martinez-Riera A. Cytomegalovirus-associated pancreatitis in acquired immunodeficiency syndrome. HPB Surg. 1992;5:181–3. discussion 183-4.PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Wilcox CM, Forsmark CE, Grendell JH, Darragh TM, Cello JP. Cytomegalovirus-associated acute pancreatic disease in patients with acquired immunodeficiency syndrome. Report of two patients. Gastroenterology. 1990;99:263–7.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Wolf P, Reiser JR, Fellow JE, Haghighi P. Pancreatitis in patients with AIDS presumptively due to CMV. J Clin Lab Anal. 1989;3:152–5.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Joe L, Ansher AF, Gordin FM. Severe pancreatitis in an AIDS patient in association with cytomegalovirus infection. South Med J. 1989;82:1444–5.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Osiro S, Muhammad R, Ruiz J, Sladen A, Mathenge N, Tiwari KJ. Acute necrotizing pancreatitis in the setting of CMV viremia and AIDS: a case report and review of literature from 1980 to 2012. J Pancreas. 2012.
  49. 49.
    Perdan-Pirkmajer K, Koren-Kranjc M, Tomšič M. A successfully treated pancreatitis caused by a CMV infection in a lupus patient. Lupus. 2011;20:1104. Scholar
  50. 50.
    Konstantinou GN, Liatsos CN, Patelaros EG, Karagiannis SS, Karnesis LI, Mavrogiannis CC. Acute pancreatitis associated with herpes simplex virus infection: report of a case and review of the literature. Eur J Gastroenterol Hepatol. 2009;21:114–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Olivieri C, Nanni L, Taddei A, Manzoni C, Pintus C. Acute pancreatitis associated with herpes simplex virus infection in a child. Pancreas. 2012;41:330–1.PubMedCrossRefGoogle Scholar
  52. 52.
    Shintaku M, Umehara Y, Iwaisako K, Tahara M, Adachi Y. Herpes simplex pancreatitis. Arch Pathol Lab Med. 2003;127:231–4.PubMedGoogle Scholar
  53. 53.
    Cappell MS, Hassan T. Pancreatic disease in AIDS. J Clin Gastroenterol. 1993;17:254–63.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Vergara G, Persing B, Nicholas W. Suspected mycobacterium avium-intracellulare as an acute cause of pancreatitis in patient with acquired immunodeficiency syndrome. J Inv Med. 2005;53:S254.Google Scholar
  55. 55.
    Hawkins CC, Gold JW, Whimbey E, Kiehn TE, Brannon P, Cammarata R, Brown AE, Armstrong D. Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1986;105:184–8.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Benson CA. Treatment of disseminated disease due to the mycobacterium avium complex in patients with AIDS. Clin Infect Dis. 1994;18:S237–42.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Salahuddin A, Saif MW. Pancreatic tuberculosis or autoimmune pancreatitis. Case Rep Med. 2014;2014:410142.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Khan R, Abid S, Jafri W, Abbas Z, Hameed K, Ahmad Z. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians. World J Gastroenterol. 2006;12:6371–5.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Desmond NM, Kingdon E, Beale TJ, Coker RJ, Tanner AG, Harris JW. Tuberculous pancreatic abscess: an unusual manifestation of HIV infection. J R Soc Med. 1995;88:109P–10P.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Jaber B, Gleckman R. Tuberculous pancreatic abscess as an initial AIDS-defining disorder in a patient infected with the human immunodeficiency virus: case report and review. Clin Infect Dis. 1995;20(4):890–4.PubMedCrossRefGoogle Scholar
  61. 61.
    Knowles KF, Saltman D, Robson HG, Lalonde R. Tuberculous pancreatitis. Tubercle. 1990;71:65–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Day AA, Gibbs WM. The action of pancreatic juice on bacteria. J Infect Dis. 1930;46:26–30.CrossRefGoogle Scholar
  63. 63.
    Franco-Paredes C, Leonard M, Jurado R, Blumberg HM, Smith RM. Tuberculosis of the pancreas: report of two cases and review of the literature. Am J Med Sci. 2002;323:54–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Porter AE. The bacteriolytic action of gland extracts on tubercle bacilli. J Hyg (Lond). 1917;16:55–65.CrossRefGoogle Scholar
  65. 65.
    Bonacini M, Nussbaum J, Ahluwalia C. Gastrointestinal, hepatic, and pancreatic involvement with cryptococcus neoformans in AIDS. J Clin Gastroenterol. 1990;12:295. Scholar
  66. 66.
    Lee CH, Liao KH, Lin HY, Lui TN, Ou TY, Sen LW. Cryptococcal meningitis complicated with a large abdominal cyst mimicking acute pancreatitis. J Microbiol Immunol Infect. 2016;49:466. Scholar
  67. 67.
    Zazzo JF, Pichon F, Renier B. HIV and the pancreas. [Letter]. Lancet. 1987;2:1212–3.Google Scholar
  68. 68.
    Cohen OJ, Stoeckle MY. Extrapulmonary pneumocystis carinii infections in the acquired immunodeficiency syndrome. Arch Intern Med. 1991;151:1205–14.PubMedCrossRefGoogle Scholar
  69. 69.
    Karam MB, Mosadegh L. Extra-pulmonary pneumocystis jirovecii infection: a case report. Braz J Infect Dis. 2014;18:681–5.PubMedCrossRefGoogle Scholar
  70. 70.
    Miller R, Huang L. Pneumocystis jirovecii infection. Thorax. 2004;59:731–3.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    O’Neal CB, Ball SC. Splenic pneumocystosis: an atypical presentation of extrapulmonary pneumocystis infection. AIDS Read. 2008;18:503–8.PubMedGoogle Scholar
  72. 72.
    Anwar KP, Malik A, Subhan KH. Profile of candidiasis in HIV infected patients. Iran J Microbiol. 2012;4:204–9.PubMedPubMedCentralGoogle Scholar
  73. 73.
    Kochhar R, Noor MT, Wig J. Fungal infections in severe acute pancreatitis. J Gastroenterol Hepatol. 2011;26:952–9.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Trikudanathan G, Navaneethan U, Vege SS. Intra-abdominal fungal infections complicating acute pancreatitis: a review. Am J Gastroenterol. 2011;106:1188–92.PubMedCrossRefGoogle Scholar
  75. 75.
    Singh N, Yu VL, Rihs JD. Invasive aspergillosis in AIDS. South Med J. 1991;84:822–7.PubMedCrossRefGoogle Scholar
  76. 76.
    Young RC, Bennett JE, Vogel CL, Carbone PP, VT DV. Aspergillosis. The spectrum of the disease in 98 patients. Medicine (Baltimore). 1970;49:147–73.CrossRefGoogle Scholar
  77. 77.
    Guice KS, Lynch M, Weatherbee L. Invasive aspergillosis: an unusual cause of hemorrhagic pancreatitis. Am J Gastroenterol. 1987;82(6):563–5.PubMedGoogle Scholar
  78. 78.
    Coronado O, Mastroianni A, Scarani P, Manfredi R, Chiodo F. Toxoplasmic pancreatitis in a patient with AIDS. Med Mal Infect. 1995;25(10):1014–6.CrossRefGoogle Scholar
  79. 79.
    Ahuja SK, Ahuja SS, Thelmo W, Seymour A, Phelps KR. Necrotizing pancreatitis and multisystem organ failure associated with toxoplasmosis in a patient with AIDS. Clin Infect Dis. 1993;16:432–4.PubMedCrossRefGoogle Scholar
  80. 80.
    Gandhi S, Lyubsky S, Jimenez-Lucho V. Adult respiratory distress syndrome associated with disseminated toxoplasmosis. Clin Infect Dis. 1994;19:169–71.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    OʼConnor RM, Shaffie R, Kang G, Ward HD. Cryptosporidiosis in patients with HIV/AIDS. AIDS. 2011;25:549–60.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Hawkins SP, Thomas RP, Teasdale C. Acute pancreatitis: a new finding in cryptosporidium enteritis. Br Med J (Clin Res Ed). 1987;294:483–4.CrossRefGoogle Scholar
  83. 83.
    Norby SM, Bharucha AE, Larson MV, Temesgen Z. Acute pancreatitis associated with cryptosporidium parvum enteritis in an immunocompetent man. Clin Infect Dis. 1998;27:223–4.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Sparks H, Nair G, Castellanos-Gonzalez A, White AC Jr. Treatment of cryptosporidium: what we know, gaps, and the way forward. Curr Trop Med Rep. 2015;2:181–7.PubMedPubMedCentralCrossRefGoogle Scholar
  85. 85.
    Millet A, Singh S, Gittens-Backus G, Dang KA, Shokrani B. An unusual case of invasive Kaposi’s sarcoma with primary effusion lymphoma in an HIV positive patient: case report and literature review. Case Rep Oncol Med. 2015;2015:1. Scholar
  86. 86.
    Pantanowitz L, Dezube BJ. Kaposi sarcoma in unusual locations. BMC Cancer. 2008;8:190.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Menges M, Pees HW. Kaposi’s sarcoma of the pancreas mimicking pancreatic cancer in an HIV-infected patient: clinical diagnosis by detection of HHV 8 in bile and complete remission following antiviral and cytostatic therapy with paclitaxel. Int J Gastrointest Cancer. 1999;26:193–200.CrossRefGoogle Scholar
  88. 88.
    Knowles DM. Etiology and pathogenesis of AIDS-related non-Hodgkin’s lymphoma. Hematol Oncol Clin North Am. 2003;17:785. Scholar
  89. 89.
    Jimeno Sainz A, Blázquez Encinar JC, García-Herola A, De Teresa Parreño L. Acute pancreatitis as the first manifestation of pancreatic Burkitt’s lymphoma in a patient infected by the human immunodeficiency virus. Am J Med. 2001;110:744.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Lee M-K, Jeon S-W, Lee Y-D, Seo H-E, Cho C-M, Kim S-G, Yoon Y-K. A case of primary pancreatic non-Hodgkin’s lymphoma. Korean J Intern Med. 2006;21:123–6.PubMedPubMedCentralCrossRefGoogle Scholar
  91. 91.
    Baysal B, Kayar Y, Ince AT, Arici S, Türkmen I, Şentürk H. Primary pancreatic lymphoma: a rare cause of pancreatic mass. Oncol Lett. 2015;10:1701–3.PubMedPubMedCentralCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Infectious Diseases, University of Connecticut School of MedicineFarmingtonUSA
  2. 2.Division of Infectious Diseases, Saint Francis Hospital and Medical CenterHartfordUSA

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