Plasmapheresis in the treatment of an acute pancreatitis due to protease inhibitor-induced hypertriglyceridemia

The use of protease inhibitors such as ritonavir to treat HIV-infected indi viduals has been associated with lipodystrophy, combined hyperlipidemias, a nd hypertriglyceridemia-induced pancreatitis. We report hereon the treatmen t by plasmapheresis of a HIV-patient who presented with a rapid onset of se vere ritonavir-induced hypertriglyceridemia complicated with an acute pancr eatitis. A 35-year-old HIV-1 positive male following 3 weeks of ritonavir t reatment presented with nausea, abdominal pain, a distended abdomen, and th e following laboratory values: amylase (238 U/L), lipase (864 U/L), total c holesterol (27.1 mmol/L), and triglycerides (62.9 mmol/L). Following two pl asmaphereses, the levels of total cholesterol, triglycerides, lipase, and a mylase declined drastically and the patient was discharged home after 4 day s with lipid and pancreatic enzyme levels within the reference range. To ou r knowledge, this is the first case of pancreatitis due to a PI-induced hyp erlipidemia in a HIV-patient treated with plasmapheresis in an acute settin g. (C) 2001 Wiley-Liss, Inc.