Sleeve Gastrectomy Is a Safe and Efficient Procedure in HIV Patients with Morbid Obesity: a Case Series with Results in Weight Loss, Comorbidity Evolution, CD4 Count, and Viral Load

Abstract

The sleeve gastrectomy was safe and effective with no consequences on CD4 counts and viral load in HIV-affected obese patients. It should be considered as a part of the treatment in morbidly obese HIV patients.

Antiretroviral considerations in HIV-infected patients undergoing bariatric surgery

“…Therapeutic drug monitoring of raltegravir in the setting of bariatric surgery is limited to two published cases. A 44‐year‐old woman with HIV infection who underwent sleeve gastrectomy was noted to have a raltegravir concentration of 372 ng/mL 16 hours following administration . The authors of this report cited a recommended raltegravir concentration of >150 ng/mL at 12 hours from administration.…”

“…Following bariatric surgery, the patient was noted to have an etravirine serum level of 1800 ng/mL at an unknown time period and a serum level of 1690 ng/mL at 16 hours from administration. According to the authors of this report, the recommended concentration of etravirine at 24 hours from administration is 300‐470 ng/mL . The patient was able to maintain viral suppression postoperatively.…”

“…A 44‐year‐old woman was noted to have a preoperative ritonavir serum level of 1300 ng/mL at 12 hours from administration. Following bariatric surgery, the ritonavir serum level was 580 ng/mL at an unknown time interval and fell to undetectable levels at 16 hours from administration . Both patients from this case series maintained viral suppression postoperatively.…”

“…Of the 78 patients with HIV infection identified in the literature who underwent bariatric surgery, 15% of patients had some form of complication. These complications were unrelated to HIV, most commonly minor, and generally occurred during the early postoperative period with a limited number of patients experiencing a complication one‐year after surgery . Of these patients being treated for HIV in whom viral load data were reported, 96% (45/47) remained virally suppressed following bariatric surgery .…”

Long-term virologic outcomes following bariatric surgery in patients with HIV

“…Some studies have demonstrated sub-therapeutic serum drug concentrations in HIV-infected patients after these procedures [7,8]. Regional delivery of oral ART medications to different portions of the upper gastrointestinal tract may influence systemic bioavailability [9], and the need for co-administered antacid therapy in the post-operative period may impair the gastrointestinal absorption of atazanavir [10].…”