In obese people living with HIV (PLWH) in the Netherlands, bariatric surgery was found to be effective for weight loss and the control of lipids, without a clear link to poor virologic control.
About This Study
“Outcomes of bariatric surgery in people with HIV: a retrospective analysis from ATHENA cohort” was published online on July 1, 2023, in Clinical Infectious Diseases. The lead author is Leena Zino, M.Sc., of the Department of Pharmacy at Radboud University Medical Center, and of the Radboudumc Research Institute for Medical Innovation (RIMI) in Nijmegen, Netherlands.
Key Research Findings
This retrospective analysis evaluated the outcome of bariatric surgery in participants in the Dutch ATHENA cohort of PLWH on antiretroviral therapy (ART), 51 of whom had such surgery, mainly gastric bypass, between 2004 and 2022. The median age was 46 years, 55% of participants were women, and the median body mass index (BMI) before surgery was 39.8 kg/m2. Forty-three participants were virally suppressed prior to the procedure and most of the rest had a viral load (VL) < 200 copies/mL. One person had a VL of 6,000 copies/mL and a history of non-adherence to ART.
During up to 18 months of follow-up after the surgery, one participant experienced viral failure and three had viral blips. Four of the eight participants who were viremic at surgery were virally suppressed by study end and no viral load data were available for the remaining four participants, including the person with the high VL pre-surgery.
Similar to results seen in the general population, 85% of participants lost >20% of their body weight and most lipid parameters improved significantly. While systolic blood pressure improved after surgery, it was not statistically significant. However, the use of hypertensive medications dropped after the surgery. At baseline, participants took a total of 203 drugs, 62 of which were obesity-related. These numbers dropped to 103 drugs total, 25 of which were obesity-related, by the end of the study.
Discussion Highlights and Implications for Practice
Study limitations included the small sample size, lack of therapeutic drug monitoring at the time of viral failure and viral blips, and the absence of information on drug adherence during the study period. In addition, therapeutic drug monitoring did not include all currently available antiretrovirals, the authors said.
“Caution should be used in people with a history of [viral failure] or ART non-adherence at [bariatric surgery] to avoid the risk of subtherapeutic exposure to ART and the subsequent poor virologic control,” the study authors concluded.