Abstract
PurposeHuman immunodeficiency virus (HIV)–related mortality has decreased secondary to advances in antiretroviral therapy (ART), and the incidence of obesity in this population is increasing. Bariatric surgery is an effective method of weight loss, though changes in the gastrointestinal tract may affect ART absorption and virologic suppression. Existing data are limited to case reports studying outdated therapeutic regimens; studies evaluating modern ART regimens are needed. The objective of this study was to determine if undergoing bariatric surgery impacts HIV virologic failure rate at 12 months post-surgery and to characterize the failure population.Materials and MethodsThis retrospective case series included adults with virologically suppressed HIV on ART who underwent roux-en-y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery between 2000 and 2019 (n=20) at one of three medical centers within one academic medical system. The primary outcome was proportion of patients with ART failure at 12 months post-surgery. Select additional data collected included CD4+ count, metabolic parameters, postoperative complications, and medication non-adherence.ResultsA total of 18 patients were included in this analysis. Seventeen of 18 patients (94%) maintained virologic suppression within 12 months post-surgery. There were no significant changes in CD4+ counts before and after surgery. The one failure was an African American woman who underwent sleeve gastrectomy surgery. This patient’s baseline viral load was undetectable and CD4+ count was 263 cells/mm3.ConclusionUndergoing bariatric surgery did not increase virologic failure rate in a small cohort of persons living with HIV, and ART non-adherence was associated with virologic failure.Graphical abstract
Highlights
Advances in antiretroviral therapy (ART) have significantly prolonged acquired immunodeficiency syndrome-free survival rates in persons living with human immunodeficiency virus (HIV)
Bariatric surgery is safe in patients with HIV who are suppressed at baseline
A 2015 study estimated that the prevalence of obesity in men living with HIV engaged in medical care is about 19%, that of women is 42% [1], and most patients will gain weight during HIV infection and while on antiretroviral therapy [2,3,4]
Summary
Advances in antiretroviral therapy (ART) have significantly prolonged acquired immunodeficiency syndrome-free survival rates in persons living with human immunodeficiency virus (HIV). These persons become more prone to comorbidities associated with the aging population, such as obesity. Two common weight-loss surgeries are roux-en-y gastric bypass (RYGB) and sleeve gastrectomy (SG), both of which can be performed laparoscopically. During these procedures, the surface area of the stomach (and intestine in RYGB) is physically altered and the pH of the stomach increases as its size shrinks, becoming closer to that of the small intestine [8]
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