Virologic Outcomes of Antiretroviral Therapy in HIV-1 Infected Patients Following Bariatric Surgery: A Case Series

Badowski, Melissa E; Kassem, Sally; Taylor, Christopher G.; McKamey, Lacie; Janelle, Jennifer; Lamadrid, Ernesto; Bunnell, Kristen; Huesgen, Emily

doi:10.1093/ofid/ofw172.1229

Cited by 4 publications

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“…Existing data on the efficacy of ART in persons living with HIV who have undergone bariatric surgery are limited to small-scale case reports that study outdated therapeutic regimens. Based on these case reports, virologic suppression was maintained after bariatric surgery in most subjects [9][10][11][12][13][14], though one prospective study of HIV patients undergoing SG found higher rates of virologic failure [15]. Of note, these studies included small sample sizes ranging from 1 to 17 subjects and studied antiretrovirals that are no longer used first line.…”

Section: Key Pointsmentioning

confidence: 99%

Antiretroviral Therapy Efficacy Post-Bariatric Weight Loss Surgery: A Case Series of Persons Living with Human Immunodeficiency Virus

2022

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Purpose Human 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 Existing data are limited to case reports studying outdated therapeutic regimens; studies evaluating modern ART regimens are needed.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 Methods This 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. Results A 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. Conclusion Undergoing 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

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Section: Key Pointsmentioning

confidence: 99%

Antiretroviral Therapy Efficacy Post-Bariatric Weight Loss Surgery: A Case Series of Persons Living with Human Immunodeficiency Virus

2022

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Implications of Bariatric Surgery on the Pharmacokinetics of Antiretrovirals in People Living with HIV

et al. 2022

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Bariatric surgery is increasingly applied among people living with HIV to reduce obesity and the associated morbidity and mortality. In people living with HIV, sufficient antiretroviral exposure and activity should always be maintained to prevent development of resistance and disease progression. However, bariatric surgery procedures bring various gastrointestinal modifications including changes in gastric volume, and acidity, gastrointestinal emptying time, enterohepatic circulation and delayed entry of bile acids. These alterations may affect many aspects of antiretroviral pharmacokinetics. Some drug characteristics may result in subtherapeutic exposure and the potential related risk of treatment failure and resistance. Antiretrovirals that require low pH, administration of fatty meals, longer intestinal exposure, and an enterohepatic recirculation for their absorption may be most impacted by bariatric surgery procedures. Additionally, some antiretrovirals can interact with the polyvalent cations in supplements or drugs inhibiting gastric acid, thereby preventing their use as these comedications are commonly prescribed post-bariatric surgery. Predicting pharmacokinetics on the basis of drug characteristics solely proved to be challenging, therefore pharmacokinetic studies remain crucial in this population. Here, we discuss general implications of bariatric surgery on antiretroviral outcomes in people living with HIV as well as drug properties that are relevant for the choice of antiretroviral treatment in this special patient population. Additionally, we summarise studies that evaluated the pharmacokinetics of antiretrovirals post-bariatric surgery. Finally, we performed a comprehensive analysis of theoretical considerations and published pharmacokinetic and pharmacodynamic data to provide recommendations on antiretrovirals for people living with HIV undergoing bariatric surgery.

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Antiretrovirals

2019

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Virologic Outcomes of Antiretroviral Therapy in HIV-1 Infected Patients Following Bariatric Surgery: A Case Series

Cited by 4 publications

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Antiretroviral Therapy Efficacy Post-Bariatric Weight Loss Surgery: A Case Series of Persons Living with Human Immunodeficiency Virus

Antiretroviral Therapy Efficacy Post-Bariatric Weight Loss Surgery: A Case Series of Persons Living with Human Immunodeficiency Virus

Implications of Bariatric Surgery on the Pharmacokinetics of Antiretrovirals in People Living with HIV

Antiretrovirals

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