Incidence of acute pancreatitis and nucleoside reverse transcriptase inhibitors usage.

Acute pancreatitis (AP) is a well-known adverse effect of nucleoside reverse transcriptase inhibitors (NRTIs). Therefore, we performed a prospective, cohort study to examine the incidence rates (IRs) and rate ratios (RRs) of AP for each NRTI. A total of 116 HIV patients were included in the final analysis comprising 445.6 person-years of follow-up. Twelve cases of AP were recorded. The lowest IR for AP was for didanosine (ddI) (IR=0.03 per 100 person-years, 95% confidence interval [CI] = 0.01-0.05), and the highest for ddI + stavudine (d4T) (IR = 0.08, 95% CI = 0.07-012). Compared with ddI alone, the RR of AP was 2.21 (95% CI = 1.32-9.31) for d4T, and 3.13 (95% CI = 1.43-12.56) for ddI + d4T. Other risk factors for AP were CD4 cell count <200 cells/mm(3) and female sex. Our results suggest that the use of d4T alone or combined with ddI should not be used as first-line therapy, especially in women or patients with CD4-cell count <200 cells/mm(3).