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Acute pancreatitis: case report A 32-year-old man developed acute pancreatitis during treatment with bictegravir/emtricitabine/tenofovir-alafenamide for HIV infection. The man, who was diagnosed with HIV infection, started receiving bictegravir/emtricitabine/tenofovir-alafenamide [BIC/FTC/TAF; dosage and route not stated] from December 2019. Baseline laboratory tests revealed the following: HIV-RNA 355,000 copies/mL, CD4+ cell count 583 cells/mm3, AST 26 IU/L, ALT 19 IU/L, GGT 15 IU/L, total bilirubin 0.6 mg/dL, lipase 21 IU/L, amylase 16 IU/L and triglycerides 93 mg/dL. Forty-five days after initiation of bictegravir/emtricitabine/tenofovir-alafenamide, he presented to a hospital in Italy with severe epigastric pain radiating to the back, nausea, episodes of non-bloody non-bilious vomiting and anorexia. At this presentation, laboratory tests revealed the following: elevated lipase 219 IU/L, with normal AST 23 IU/L and normal ALT 19 IU/L. Ultrasound of the abdomen revealed a non-homogeneous structure of the pancreatic parenchyma. No stones in the biliary tree and gallbladder were found. His medical history and family history were insignificant for hypertriglyceridemia and pancreatitis, respectively. No evidence or history of alcohol abuse was observed. History of use of any other drugs, dietary supplements or illegal substances was not evident. Based on the above-mentioned results, he was diagnosed with mild bictegravir/emtricitabine/tenofoviralafenamide-related acute pancreatitis. The man’s treatment with bictegravir/emtricitabine/tenofovir-alafenamide was therefore discontinued. A subsequent and rapid improvement in the symptoms was observed. Two weeks after discontinuation of bictegravir/emtricitabine/tenofovir-alafenamide, the lipase level normalised. Then, he started receiving antiretroviral regimen with rilpivirine and dolutegravir. As per the Naranjo drug causality assessment criteria, a ’probable’ association between bictegravir/emtricitabine/tenofovir-alafenamide and acute pancreatitis was assessed (a score of 5). Riva A, et al. Bictegravir/emtricitabine/tenofovir alafenamide-induced acute pancreatitis: a case report. International Journal of STD and AIDS 31: 1008-1010, No. 10, 01 Sep 803507139 2020. Available from: URL: http://doi.org/10.1177/0956462420934981

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Reactions 17 Oct 2020 No. 1826