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Obesity Surgery

, Volume 28, Issue 9, pp 2886–2893 | Cite as

Sleeve Gastrectomy in Morbidly Obese HIV Patients: Focus on Anti-retroviral Treatment Absorption After Surgery

  • Chloé Amouyal
  • Marion Buyse
  • Lea Lucas-Martini
  • Déborah Hirt
  • Laurent Genser
  • Adriana Torcivia
  • Jean-Luc Bouillot
  • Jean-Michel Oppert
  • Judith Aron-WisnewskyEmail author
Original Contributions

Abstract

Context

Anti-retroviral therapy (ART) dramatically reduced AIDS development, thus enabling patients to live as long as the general population. New challenges have emerged particularly cardiometabolic diseases and weight gain, with some HIV patients seeking bariatric surgery (BS). However, BS outcomes during HIV remain poorly described, with scarce data on ART pharmacokinetic post-BS.

Objective

Describing sleeve gastrectomy (SG) results in HIV patients in terms of ART pharmacokinetic, HIV control, weight loss, and metabolic outcomes.

Design, Setting, and Patients

Prospective study of HIV patients undergoing SG in a referral academic center, with at least 6 months follow-up.

Main Outcome Measure

Clinical and biological parameters, HIV medical history, and ART pharmacokinetics were gathered before and post-SG.

Results

Seventeen patients (mean BMI = 44.2 ± 5.7 kg m−2) and major obesity-related diseases (47% type-2 diabetes, 64% obstructive sleep apnea, 70% hypertension) underwent SG during a mean 2 years of follow-up. They displayed an average of 20% reduction of initial BMI and improved body composition, similarly to obese non-HIV patients. SG improved metabolic status. All patients had undetectable viral load before BS. Upon HIV follow-up, 12 patients had undetectable viral load with correct ART kinetic parameters (3 and 6 months); 4 displayed detectable viral load along with significant decrease in raltegravir and atazanavir treatment exposure, leading to ART change with subsequent undetectable viral load; and 1 had persistent detectable viral load despite ART change.

Conclusions

SG seems effective and safe in obese HIV patients. However, ART treatment should be monitored post-SG to control HIV infection. We suggest that some ART should be adapted before SG conjoints with infectious disease specialists.

Keywords

Bariatric surgery Sleeve gastrectomy HIV Pharmacokinetics Anti-retroviral therapy 

Notes

Acknowledgements

The authors wish to thank Ms. Valentine Lemoine for her help in data collection and Dr. Florence Marchelli, MD, for her contribution to management of the clinical and biological database.

Financial Support

This study is supported by CRC fibrota (AP-HP).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11695_2018_3308_Fig4_ESM.gif (171 kb)
Supplementary Fig. 1

Pharmacokinetic profile for safe ART at baseline and post-BS: Cmin, Cmax, and AUC are represented for each drug at baseline (black) compared with literature optimal concentrations (red) and 3 months post-SG (blue). a Pre- and post-surgery and literature [28] of lamivudine, data expressed in mean ± standard deviation; b pre- and post-surgery and literature [29] of abacavir, data expressed in mean ± standard deviation; c pre- and post-surgery and literature [30] of darunavir, data expressed in mean ± min and max. (GIF 170 kb)

11695_2018_3308_MOESM1_ESM.tif (125 kb)
High-resolution image (TIF 124 kb)
11695_2018_3308_Fig5_ESM.gif (227 kb)
Supplementary Fig. 2

Corpulence evolution in obese HIV patients as compared with non-HIV obese patients: a non-significant difference weight evolution between the two groups at baseline and during the first year of follow-up and b non-significant body composition evolution between the two groups at baseline and during the first year of follow-up (GIF 226 kb)

11695_2018_3308_MOESM2_ESM.tif (499 kb)
High-resolution image (TIF 499 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Chloé Amouyal
    • 1
    • 2
  • Marion Buyse
    • 3
  • Lea Lucas-Martini
    • 4
  • Déborah Hirt
    • 3
    • 5
  • Laurent Genser
    • 1
    • 6
  • Adriana Torcivia
    • 6
  • Jean-Luc Bouillot
    • 7
  • Jean-Michel Oppert
    • 2
    • 4
  • Judith Aron-Wisnewsky
    • 1
    • 2
    • 4
    Email author
  1. 1.INSERM, UMRS, NutriOmicsTeamSorbonne UniversitéParisFrance
  2. 2.Institute of Cardiometabolism and NutritionInstitut E3M, 83 boulevard de l’HôpitalParisFrance
  3. 3.INSERM, Saint-Antoine Research Center, Saint-Antoine HospitalSorbonne UniversitéParisFrance
  4. 4.Nutrition Department, Pitié-Salpêtrière HospitalAssistance Publique Hôpitaux de Paris, Sorbonne UniversitéParisFrance
  5. 5.Pharmacology Department, Cochin HospitalAssistance Publique Hôpitaux de ParisParisFrance
  6. 6.Visceral Surgery Department, Pitié-Salpêtrière HospitalAssistance Publique Hôpitaux de Paris, Sorbonne UniversitéParisFrance
  7. 7.Visceral Surgery Department, Ambroise Paré HospitalAssistance Publique Hôpitaux de Paris, Saint Quentin Versailles UniversityParisFrance

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