HIV Infection Is Not a Contraindication to Laparoscopic Sleeve Gastrectomy for Morbid Obesity.

Abstract

The efficacy of antiretroviral therapy has made HIV a chronic condition. The prevalence of obesity in HIV positive patients has subsequently risen and is present in 6-34% of men and 21-30% of women (Keithley et al. J Assoc Nurses AIDS Care 20(4):260-74, 2009). Sleeve gastrectomy is a safe and effective procedure for weight loss in the general population, but having HIV may bring hesitation to performing bariatric surgery for some practitioners. The aim of this study is to evaluate the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in patients with HIV. A retrospective analysis of prospectively collected data of patients with HIV who underwent LSG at a community hospital by a single surgeon was performed. Nine patients with HIV underwent LSG. Primary outcomes include weight loss at 6 and 12months and postoperative CD4 count and viral load. Secondary outcomes include alteration to antiretroviral therapy (ART). Our patients had a mean BMI of 46 (range 35-66) and were all well controlled on ART preoperatively. Mean weight loss at 12months was 40kg (range 21-55), with mean excess body weight loss 69% (range 42-112). There were no significant changes in CD4 counts, and all patients continued to have undetectable viral loads at 1year postoperatively. One patient had a change in ART, which was unrelated to bariatric surgery. There were no complications in our patient group. This is the largest series to date evaluating sleeve gastrectomy in HIV-positive patients and further supports the safety and efficacy of sleeve gastrectomy in this patient population.