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July 2002
Pancreatitis is most likely causing Amelie’s symptoms. Pancreatitis has been associated with several of the antiretroviral medications including ritonovir, lamivudine, stavudine, and didanosine. Both serum amylase and lipase should be obtained, as oftentimes HIV-infected patients will have an elevated amylase secondary to inflammation of the salivary glands. Serum lipase is more specific than amylase for acute inflammatory pancreatic disease, and should be obtained when pancreatitis is suspected. An abdominal ultrasound and CT are recommended as well for definitive diagnosis
Pancreatitis in HIV-infected patients also can be associated with opportunistic infections such as cytomegalovirus and mycobacterium. Other medications used to treat HIV-infected patients (e.g., trimethoprim-sulfamethoxazole, pentamidine) also can cause pancreatitis.
The treatment of pancreatitis includes relieving pain, resting the bowel, and restoring metabolic homeostasis. Surgical treatment is not required. If the episode is thought to be associated with antiretroviral medications, a re-challenge of medications is not advised. Children with uncomplicated acute pancreatitis usually do well and recover in less than a week.
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