Acute pancreatitis in HIV-infected patients: Are etiologies changing since the introduction of protease inhibitor therapy?

Introduction: Hypertriglyceridemia is a well-established cause of acute pancreatitis in the general population. Protease inhibitor ( PI) therapy, introduced in 1996 for HIV infection, is associated with moderate to severe hypertriglyceridemia. Aims: To determine whether the prevalence of hyperlipidemic pancreatitis in HIV-infected patients has increased since the introduction of PIs. Methodology: This was a retrospective study of patients with acute pancreatitis and HIV infection admitted to three local hospitals between 1990 and 2001. Results: Before PIs became available ( 1990 - 1995), 30 index cases of acute pancreatitis in the setting of HIV infection were identified, and one of these cases ( 3.3%) was attributed to hypertriglyceridemia. After the introduction of PIs ( 1996 - 2001), 54 cases of acute pancreatitis in HIV-infected patients were identified, and two of these cases were attributed to hypertriglyceridemia ( 3.7%; p = 0.6). In both time periods, medication-induced pancreatitis was the most common cause of pancreatitis in HIV-infected patients. Conclusion: Despite the well-established association between PIs and hypertriglyceridemia, there was no significant increase in the prevalence of hyperlipidemic pancreatitis in this HIV-infected population after the introduction of PIs. Medication-associated pancreatitis remains the most common cause of acute pancreatitis in the era of potent antiretroviral therapy.