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Fats and insulin.

We agree with several of Dr. Gagner's comments, especially those about persistent viral infection. As indicated in our case report, every attempt was made to identify a viral cause; in fact, one of our conclusions was that reactivation of CMV infection could not be absolutely excluded. As for ERCP, we agree that this is an important modality of investigation in pancreatitis. However, owing to the nature of this case and its natural evolution an anatomic or congenital cause of pancreatitis seemed unlikely at the time and seems even more so today. Pancreas divisum produces an acute or chronic relapsing form of pancreatitis, as does stenosis of the ampulla of Vater. Pancreatic tumours would result in a progressive downhill course, which was not evident in this patient. We agree that a large proportion of patients with socalled idiopathic pancreatitis may have biliary microlithiasis; this patient's bile was checked for cholesterol crystals and none were identified. Finally, we concur that exocrine and endocrine pancreatic lesions are well documented in patients with AIDS. In fact, a significant percentage of these patients come to have a diabetesmellitus-like syndrome. Although one cannot say, and we did not conclude, that HIV infection was the cause of pancreatitis in our patient, it cannot be ruled out with certainty, and the possibility needs to be investigated further.