Bariatric Surgery Safe for People with HIV on ART

A new study published in the Clinical Infectious Diseases suggests that bariatric surgery (BS) is safe for people with HIV who are on antiretroviral therapy (ART).

The implications of bariatric surgery on virologic and metabolic outcomes in people with human immunodeficiency virus (HIV; PWH) on ART are unknown. Here, researchers report a retrospective analysis up to 18 months post-BS in PWH from the AIDS Therapy evaluation in The Netherlands (ATHENA) cohort with data from all Dutch HIV treating centers.

Primary end points were a confirmed virologic failure (2 consecutive HIV-RNA measurements >200 copies/mL) and the percentage of patients who achieved >20% total body weight loss up to 18 months post-BS. Switches from baseline ART and trough plasma concentrations of antiretrovirals were also reported post-BS. Metabolic parameters and medication usage were compared pre- and post-bariatric surgery (BS).

Results

Fifty-one patients were included. One case of confirmed virologic failure and 3 cases with viral blips were detected in this cohort up to 18 months post-BS. Eighty-five percent of patients achieved >20% total body weight loss at 18 months post-BS, with a mean difference from baseline (95% confidence interval) of −33.5% (−37.7% to −29.3%).

Trough plasma concentrations of measured antiretroviral agents were all above minimum effective concentrations, except for 1 sample of darunavir. Lipid profiles, but not serum creatinine and blood pressure, improved significantly (P < .01) post-BS. Total medications and obesity-related comedications declined from 203 to 103 and from 62 to 25, respectively, at 18 months post-bariatric surgery (BS).

BS was an effective intervention for weight loss and lipid control in PWH using ART in this cohort with no clear link to poor virologic outcomes.

Reference

Leena Zino and others, Outcomes of Bariatric Surgery in People With Human Immunodeficiency Virus: A Retrospective Analysis From the ATHENA Cohort, Clinical Infectious Diseases, 2023; ciad404, https://doi.org/10.1093/cid/ciad404

Keywords

• Bariatric surgery
• Safe
• People
• HIV
• ART
• Leena Zino
• Antiretrovirals
• Weight
• Virologic failure