Page 247 - AIDSBK23C

Page 247

Antiretroviral therapy may account for some cases of pancreatitis. The nucleoside
reverse transcriptase inhibitors lamuvidine, didanosine, and stavudine have been reported to
produce pancreatitis. The use of didanosine in combination with hydroxyurea may produce a
severe and fatal pancreatitis.[996,999]
Pentamidine administered either intravenously or by aerosol for treatment of P jiroveci
(carinii), can sometimes produce acute necrotizing pancreatitis, even after months of aerosolized
pentamidine therapy, and can be potentiated by further intravenous pentamidine therapy with
higher systemic drug levels. Abdominal pain, along with increased serum amylase, suggests
pancreatitis, which can recur when pentamidine is given again. In some cases, the onset may be
rapid and the course short, ending in death. A grossly black to reddish-black pancreas with
extensive necrosis but without extensive edema, fat necrosis, or hemorrhage is typical, and
microscopic neutrophilic infiltrates may be minimal.[1000]
Pentamidine may also cause either hypo- or hyperglycemia. Hypoglycemia results from
malfunctioning beta cells in the islets of Langerhans and may be seen in up to one third of treated
patients from one to several weeks after initiating therapy. Abnormalities in regulation of
glucose are more frequently observed when there is also pentamidine-induced
nephrotoxicity.[864,993]
Trimethoprim-sulfamethoxazole may produce pancreatitis. The antiretroviral drugs
didanosine, zalcitabine, and stavudine can also cause acute pancreatitis, as evidenced by
increased serum amylase and abdominal pain, and the risk increases with cumulative dose.[261]
Patients at risk for drug-induced pancreatitis include those with previous pancreatitis, prolonged
or high-dose therapy, additional pancreaticotoxic medications, and advanced stage of
HIV.[256,993]