elevated lipase levels

Question:

Two months ago, I began participating in a clinical trial in which I am put on Crixivan, AZT and 3TC. In my most recent bloodwork, I was found to have elevated levels of lipase in my blood (450 as opposed to the norm of 140). The study nurse told me that it probably wasn't related to the drug regimen, yet told me to stop taking AZT and 3TC for the time being, and to come in for another blood draw. I have many concerns about this, but primarily, I worry about developing resistance to AZT and/or 3TC after not taking it for a few days (looks like 3.5 days at least). I am continuing to take Crixivan on schedule. Thank you for your help.

Dr. Gallant's Response:

Your concern is well founded. It is now felt that stopping some of your drugs while continuing others is unwise. This may be especially true if you are stopping the nucleosides and continuing the protease inhibitor. If there is a need to stop drugs it is probably safer to stop the entire regimen and then restart it later. That way there is no selective pressure being exerted favoring resistant mutants. Not all clinical trials have caught up with this approach, yet, but they probably will.

I don't know why your lipase is high. Lipase elevations can occur when you have pancreatitis. You didn't say whether your amylase is also high. If both are elevated, that makes pancreatitis more likely. But you don't sound sick, and that makes it less likely to be serious. None of the antiretrovirals you're taking are associated with pancreatitis.

Unfortunately, one of the down sides of being in a clinical trial is that all sorts of lab tests get ordered that would not otherwise be drawn. If you had been taking these drugs outside the trial, you probably would never have known that you had a high lipase, and there's a good chance it wouldn't have made any difference.