Acute pancreatitis is an inflammatory condition of the pancreas, which is manifested clinically as abdominal pain with elevated pancreatic enzymes—amylase and lipase. It is potentially life threatening. Pancreatitis is caused by a variety of insults to the pancreas. It is estimated that in the United States, gallstones and chronic alcoholism account for approximately 75% of acute pancreatitis cases. The incidence of pancreatitis in non-human immunodeficiency virus (HIV) patients is relatively low and ranges from 17 to 30 cases per 100,000 population. However, it is considerably higher in the U.S. HIV population. One study of prevalence in the HIV population found incidence rates as high as 14 cases per 100 patients over a 1-year period. This is thought to be due to comorbid conditions like ethanol use, medications frequently used in HIV patients (e.g., didanosine, stavudine, corticosteroids, sulfonamides, isoniazid, ketoconazole, metronidazole), and opportunistic infections like cryptosporidiosis, mycobacteria, and cytomegalovirus (CMV) disease.

HIV-positive patients are frequently admitted to the intensive care unit (ICU). In addition to pancreatitis, some of the leading indications for ICU admissions are pneumococcal pneumonia or meningitis, cryptococcal meningitis, toxoplasmosis, liver failure from co-infection with hepatitis B or C, or shock from either infections or drugs (abacavir hypersensitivity). The critically ill patient with pancreatitis on antiretroviral drugs is a challenge and ICU physicians typically base treatment decisions on physician experience rather than data from controlled studies (that largely do not exist). Clearly, if the presenting condition is pancreatitis related to the HIV therapy, the drugs should be stopped and a regimen of proximal bowel rest should be undertaken. However, it is often difficult to substitute with alternative regimes because of overlapping toxicities, previous drug resistance, or difficulties in administering the drug. In addition, in patients who are nil per os (NPO), abruptly stopping antiretroviral therapy may cause a sudden fall in CD4 (+) cell count and a rise in viral load. Some patients may even develop an acute seroconversion illness.