Last updated: December 2020
Acute pancreatitis, or inflammation of the pancreas, is a relatively rare condition. However, acute pancreatitis is much more common in people who are living with HIV.1
What is acute pancreatitis?
The pancreas is an organ in the center of the abdomen, near the stomach. It produces hormones involved in digestion. These are molecules like glucagon and insulin that balance blood sugar. It can also release molecules like somatostatin and amylin that can slow down digestion. The pancreas can also release molecules directly into the gut to help break down proteins and fats.2
Acute pancreatitis has many causes. It can often happen as a side effect of certain medicines or high triglycerides (a type of fat found in the blood). It may also be a result of heavy drinking or gallstones, which are small hardened pieces of bile.3
Acute pancreatitis causes sharp pain in the center or upper right side of the stomach. The pain may also feel like it is moving toward your back. Many people with acute pancreatitis feel nauseous or vomit.3
How is acute pancreatitis related to HIV?
Recent research has studied why people who are living with HIV are more likely to have acute pancreatitis. Researchers found that most cases were caused by medicines or infections.4
Infections or HIV medications
When CD4 cell counts are low, the immune system is not working well. This makes infection more likely; these infections may affect the pancreas. Also, medicines commonly used to treat infections may affect the pancreas.1
Certain HIV medications can damage the pancreas. Nucleotide reverse transcriptase inhibitors (NRTIs), such as didanosine and stavudine, are associated with acute pancreatitis. Taking these medicines together or taking high doses of 1 drug can also increase the risk.1
Protease inhibitors (PIs) are another common kind of drug used to treat HIV. They can cause incredibly high triglyceride levels, which can often result in acute pancreatitis. However, researchers have found that PIs do not increase the likelihood of pancreatitis in those living with HIV.1
Increased viral load or excessive alcohol use
The pancreas may also be damaged by HIV itself. Research has shown that the risk of pancreatitis increases if a person has a high viral load. Finally, excessive alcohol use can increase the risk of pancreatitis if a person is living with HIV.1
Diagnosis and treatment
Treatment for acute pancreatitis starts in the emergency room. Doctors will examine your stomach, run blood tests, and possibly order images like X-rays or CT scans. This helps them determine if it is acute pancreatitis or something else. Stomach ulcers and cholecystitis (inflammation of the gallbladder) can feel similar but will have different test results.3
Treatment based on the underlying cause
If you are diagnosed with acute pancreatitis, your doctor may want you to stay in the hospital for a few days. You will most likely receive IV fluids and pain medications. Acute pancreatitis may be caused by an infection. This is more likely if you have a low CD4 count. In this case, you may also receive antibiotics. If it was caused by one of your medicines, your primary care physician may switch you to a different drug.3
If you think that you may have acute pancreatitis, speak to your doctor.