Bariatric surgery safe for people with HIV who are on ART
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Key takeaways:
- Patients in a study lost a mean of 33% of their body weight within 18 months of undergoing the procedure.
- Nearly all ART regimens remained effective in patients in the small cohort.
Bariatric surgery is safe for people with HIV whose viral load is being managed using ART, according to a study published in Clinical Infectious Diseases.
In recent years, ART-associated obesity has likely been underestimated, according to experts.
“People with HIV are showing increased obesity rates that are similar or higher to those of the general population,” Leena Zino, a PhD candidate at Radboud University Medical Center in Nijmegen, The Netherlands, and colleagues wrote.
They noted that a sedentary lifestyle and increased dietary intake play a role but that studies have indicated that integrase inhibitors and tenofovir alafenamide fumarate have been linked to escalating rates of obesity and metabolic diseases in people with HIV.
“Particularly in people with HIV, obesity is associated with a greater risk of morbidity and mortality, including a higher incidence of cardiovascular diseases, diabetes and hyperglycemia compared to the general population,” the researchers wrote.
Zino and colleagues analyzed data on 51 patients with HIV up to 18 months after bariatric surgery (BS) from the ATHENA cohort in The Netherlands. The primary endpoints of the analysis were a confirmed virologic failure (VF) and the percentage of patients achieving a total body weight loss of more than 20% in the 18 months after surgery.
Of the participants, there was one case of VF and three cases with viral blips in the 18 months after BS. Overall, 85% of study participants achieved at least 20% body weight loss, with the mean difference from baseline at a loss of 33.5% of body weight.
Additionally, plasma concentrations of measured ART medications were nearly all greater than “minimum concentrations” and lipid profiles improved significantly. Serum creatine and blood pressure did not improve, according to the study, but total medications and obesity-related medications decreased from 203 drugs to 103 drugs and 62 drugs to 25 drugs, respectively.
“Our — albeit limited — results of plasma concentrations indicate that BS had no detrimental effect on the plasma concentrations of elvitegravir, dolutegravir, emtricitabine and tenofovir,” the researchers wrote. “The latter three drugs are particularly important because their combination is a preferred first-line treatment option in most HIV treatment guidelines.”
Although the researchers note that this study is small and that clinicians should be cautious in people with a history of virological failure or non-adherence to ART regimens, they said BS may be effective for many people with both HIV and obesity.
“These initial data from a small cohort indicate that BS as a beneficial intervention in obese people with HIV using ART with no clear worsening of virologic control,” researchers wrote, adding that “weight and lipid profiles improved significantly post-BS in people with HIV.”
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