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

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Abstract
The use of protease inhibitors such as ritonavir to treat HIV‐infected individuals has been associated with lipodystrophy, combined hyperlipidemias, and hypertriglyceridemia‐induced pancreatitis. We report here on the treatment by plasmapheresis of a HIV‐patient who presented with a rapid onset of severe ritonavir‐induced hypertriglyceridemia complicated with an acute pancreatitis. A 35‐year‐old HIV‐1 positive male following 3 weeks of ritonavir treatment presented with nausea, abdominal pain, a distended abdomen, and the following laboratory values: amylase (238 U/L), lipase (864 U/L), total cholesterol (27.1 mmol/L), and triglycerides (62.9 mmol/L). Following two plasmaphereses, the levels of total cholesterol, triglycerides, lipase, and amylase declined drastically and the patient was discharged home after 4 days with lipid and pancreatic enzyme levels within the reference range. To our knowledge, this is the first case of pancreatitis due to a PI‐induced hyperlipidemia in a HIV‐patient treated with plasmapheresis in an acute setting. J. Clin. Apheresis. 16:157–159, 2000.