Obesity Surgery

, Volume 25, Issue 2, pp 229–233 | Cite as

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

  • Marinos Fysekidis
  • Régis Cohen
  • Mohamed Bekheit
  • Joseph Chebib
  • Abdelghani Boussairi
  • Hélène Bihan
  • Marie Aude Khuong
  • Laurent Finkielsztejn
  • Gabriela Mendoza
  • Sophie Abgrall
  • Djiba Condé
  • Jean Marc Catheline



The efficacy and safety of bariatric surgery have been poorly studied in patients affected with HIV. Although sleeve gastrectomy (SG) is the most widely used procedure in many countries, most of the published literature reported results with the gastric bypass (GBP) procedure on morbidly obese HIV patients.


We have evaluated retrospectively, in eight consecutive patients who underwent a SG, its effect in weight loss and its impact on the treatment and on the markers of HIV infection.


Seven out of eight patients were females. The mean age was 46 years, with a median preoperative BMI of 42 kg/m2. The mean duration of HIV infection and CD4 cell count were 13.4 years and 457 cells/mm3, respectively. The mean weight loss was 37 kg in 20 months, the excess BMI loss was 80.8 ± 30.9 %, and the excess weight loss is 81.5 ± 28.9 % with one minor complication. CD4 counts were unchanged. Three patients had therapy modifications that were unrelated to bariatric surgery. Two patients had a therapeutic drug monitoring before and after the intervention. Plasma concentrations remained in therapeutic levels after the SG. Most comorbidities disappeared postoperatively, decreasing the cardiovascular risk.


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.


Obesity Sleeve gastrectomy HIV 


Conflict of Interest

All authors declare no conflict of interest.


  1. 1.
    UNAIDS report on the global AIDS epidemic 2013. [cited 29 October 2013]; Available from: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf.
  2. 2.
    Keithley JK, Duloy AM, Swanson B, et al. HIV infection and obesity: a review of the evidence. J Assoc Nurses in AIDS Care: JANAC. 2009;20(4):260–74.PubMedCrossRefGoogle Scholar
  3. 3.
    Miller M, Kahraman A, Ross B, et al. Evaluation of quantitative liver function tests in HIV-positive patients under anti-retroviral therapy. Eur J Med Res. 2009;14(9):369–77.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.PubMedCrossRefGoogle Scholar
  5. 5.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. JAMA: J Am Med Assoc. 2004;292(14):1724–37.CrossRefGoogle Scholar
  6. 6.
    Selke H, Norris S, Osterholzer D, et al. Bariatric surgery outcomes in HIV-infected subjects: a case series. AIDS Patient Care STDS. 2010;24(9):545–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Fried M, Yumuk V, Oppert J-M, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Facts. 2013;6(5):449–68.PubMedCrossRefGoogle Scholar
  8. 8.
    Catheline J-M, Cohen R, Khochtali I, et al. Traitement de la super obésité morbide par gastrectomie longitudinale. Presse Med. 2006;35(3):383–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Fazylov R, Soto E, Merola S. Laparoscopic gastric bypass surgery in human immunodeficiency virus-infected patients. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2007;3(6):637.CrossRefGoogle Scholar
  10. 10.
    Flancbaum L, Drake V, Colarusso T, et al. Initial experience with bariatric surgery in asymptomatic human immunodeficiency virus-infected patients. Surg Obes Relat Dis. 2005;1(2):73–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Keidar A, Hershkop KJ, Marko L, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial. Diabetologia. 2013:1-5.Google Scholar
  12. 12.
    Consten EC, Gagner M, Pomp A, et al. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg. 2004;14(10):1360–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Cohen R, Uzzan B, Bihan H, et al. Ghrelin levels and sleeve gastrectomy in super-super-obesity. Obes Surg. 2005;15(10):1501–2.PubMedCrossRefGoogle Scholar
  14. 14.
    Leeman J, Chang YK, Lee EJ, et al. Implementation of antiretroviral therapy adherence interventions: a realist synthesis of evidence. J Adv Nurs. 2010;66(9):1915–30.PubMedCentralPubMedGoogle Scholar
  15. 15.
    Sardo P, Walker JH. Bariatric surgery: impact on medication management. Hosp Pharm. 2008;43(2):113–20.CrossRefGoogle Scholar
  16. 16.
    Brocks DR, Ben-Eltriki M, Gabr RQ, et al. The effects of gastric bypass surgery on drug absorption and pharmacokinetics. Expert Opin Drug Metab Toxicol. 2012;8(12):1505–19.PubMedCrossRefGoogle Scholar
  17. 17.
    Michalaki MA, Gkotsina MI, Mamali I, et al. Impaired pharmacokinetics of levothyroxine in severely obese volunteers. Thyroid: Off J Am Thyroid Assoc. 2011;21(5):477–81.CrossRefGoogle Scholar
  18. 18.
    Kamimura M, Watanabe K, Kobayakawa M, et al. Successful absorption of antiretroviral drugs after gastrojejunal bypass surgery following failure of therapy through a jejunal tube. Intern Med. 2009;48(12):1103–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Boffito M, Lucchini A, Maiello A, et al. Lopinavir/ritonavir absorption in a gastrectomized patient. AIDS. 2003;17(1):136–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Palermo B, Bosch RJ, Bennett K, et al. Body mass index and CD4+ T-lymphocyte recovery in HIV-infected men with viral suppression on antiretroviral therapy. HIV Clin Trials. 2011;12(4):222–7.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Marinos Fysekidis
    • 1
  • Régis Cohen
    • 2
  • Mohamed Bekheit
    • 3
    • 4
  • Joseph Chebib
    • 3
  • Abdelghani Boussairi
    • 5
  • Hélène Bihan
    • 1
  • Marie Aude Khuong
    • 6
  • Laurent Finkielsztejn
    • 7
  • Gabriela Mendoza
    • 8
  • Sophie Abgrall
    • 9
  • Djiba Condé
    • 1
  • Jean Marc Catheline
    • 3
  1. 1.Service d’Endocrinologie, Diabétologie et Maladies MétaboliquesHôpital AvicenneBobignyFrance
  2. 2.Service d’EndocrinologieCentre hospitalier de Saint-DenisSaint-DenisFrance
  3. 3.Service de Chirurgie DigestiveCentre hospitalier de Saint-DenisSaint-DenisFrance
  4. 4.Department of SurgeryEl Kabbary General HospitalAlexandriaEgypt
  5. 5.Laboratoire de PharmacotoxicologieCentre hospitalier de Saint-DenisSaint-DenisFrance
  6. 6.Service de maladies infectieusesCentre hospitalier de Saint-DenisSaint-DenisFrance
  7. 7.Hôpital Cochin Maladies infectieusesSaint-JacquesFrance
  8. 8.Médecine Interne CHU André Grégoire Montreuil sous boisMontreuilFrance
  9. 9.Service de maladies infectieusesHôpital AvicenneBobignyFrance

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