Background:  Hypertriglyceridemia is a risk factor for development of acute pancreatitis in HIV-uninfected patients. The risk of acute pancreatitis remains unclear in HIV-infected patients in whom marked hypertriglyceridemia (>500 mg/dL) have developed after initiation of highly active antiretroviral therapy (HHART).

Methods:  We assessed the risk of acute pancreatitis by following 89 (10.4%) non-alcoholic HIV-infected patients, 80 males, with marked hypertriglyceridemia after receiving HAART who had a median triglyceride levels of 653 (range, 500 to 1958 mg/dL); 14 (15.7%) had a triglyceride value of 1000 mg/dL or greater; and 41 patients (46.1%) had signs consistent with lipodystrophy after treatment with antiretroviral therapy.

Results:  The incidence of acute pancreatitis in the pre-HAART era was 5.51 per 100 patient-years (95% confidence interval, 5.16, 5.87 per 100 patient-years) and that of post-HAART era was 3.60 per 100 patient-years (95% CI, 3.43, 3.77 per 100 patient-yeARS). During the observation duration of marked hypertriglyceridemia for a total of 178 patient-years, triglyceride values of 1000 mg/dL or greater persisted or recurred in approximately 10% of the 89 patients despite treatment with lipid-lowering agents and switch from protease inhibitors-containing antiretroviral therapy, with a peak triglyceride value of 3200 mg/dL. Acute pancreatitis developed in 8 patients (9.0%) with marked hypertriglyceridemia, with an incidence of 4.51 per 100 patient-years (95% CI, 4.21, 4.82 per 100 patient-years). When compared with the background incidence in the pre-HAART and post-HAART era, the incidence of acute pancreatitis did not increase in patients with marked hypertriglyceridemia (p = 0.30)

Conclusions:  Our data suggested that hypertriglyceridemia might be an irreversible result of prolonged antiretroviral therapy, which might require continuous therapy with lipid-lowering agents in 10% of the treated HIV-infected patients. The incidence of acute pancreatitis did not significantly increase with hypertriglyderidemia.

Keywords: acute pancreatitis; hypertriglyceridemia; antiretroviral therapy