Abstract
Background
Paradoxically, advances in anti-retroviral therapy that has increased survival for patients with human immunodeficiency virus (HIV) have resulted in greater numbers of HIV+ patients developing other chronic diseases, including obesity. Little comparative literature exists detailing perioperative or metabolic outcomes of bariatric surgery in the HIV+ population compared to HIV negative (HIV−) controls.
Methods
This is a retrospective case-control study with both HIV+ (case) and HIV− control patients. Individuals undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between January 1, 2006 and December 31, 2015 were included. HIV+ status was defined as any individual with documented history of HIV.
Results
Eleven HIV+ patients underwent RYGB or SG during the study period. After matching (1:5 HIV+: HIV−) both cohorts had similar mean age (42 years), gender distribution (63% female), and preoperative BMI (48 kg/m2), as well as comorbidities. There were no differences in postoperative length of stay, or all cause 30-day morbidity. There were 63.7% HIV+ and 76.4% with 1-year follow-up available. Both percent excess weight loss (56% HIV+ vs. 60% HIV−) and BMI (32 HIV+ vs. 34 kg/m2 HIV−) were similar in both groups. There were minimal changes to CD4 count or HIV viral load in the patients during the follow-up period.
Conclusion
Bariatric surgery is safe and feasible in HIV-infected population well controlled on anti-retroviral medication. The short-term surgical and metabolic outcomes are similar to HIV− controls with minimal effect on the CD4 count and viral load in HIV+ cohort for long-term follow-up.
Similar content being viewed by others
References
Hogg RS, Heath KV, Yip B, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279:450–4.
Palella FJ, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 1998;338:853–60. https://doi.org/10.1056/NEJM199803263381301.
Enanoria WT, Ng C, Saha SR, et al. Treatment outcomes after highly active antiretroviral therapy: a meta-analysis of randomised controlled trials. Lancet Infect Dis. 2004;4:414–25. https://doi.org/10.1016/S1473-3099(04)01057-6.
Keithley JK, Duloy AMS, Swanson B, et al. HIV infection and obesity: a review of the evidence. J Assoc Nurses AIDS Care. 2009;20:260–74. https://doi.org/10.1016/j.jana.2009.02.006.
Shikuma CM, Zackin R, Sattler F, et al. Changes in weight and lean body mass during highly active antiretroviral therapy. Clin Infect Dis. 2004;39:1223–30. https://doi.org/10.1086/424665.
Montessori V, Press N, Harris M, et al. Adverse effects of antiretroviral therapy for HIV infection. CMAJ. 2004;170:229–38.
Henry K, Melroe H, Huebsch J, et al. Severe premature coronary artery disease with protease inhibitors. Lancet. 1998;351:1328. https://doi.org/10.1016/S0140-6736(05)79053-X.
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376:641–51. https://doi.org/10.1056/NEJMoa1600869.
Flancbaum L, Drake V, Colarusso T, et al. Initial experience with bariatric surgery in asymptomatic human immunodeficiency virus-infected patients. Surg Obes Relat Dis. 1:73–6. https://doi.org/10.1016/j.soard.2005.02.004.
Shor-Posner G, Campa A, Zhang G, et al. When obesity is desirable: a longitudinal study of the Miami HIV-1-infected drug abusers (MIDAS) cohort. J Acquir Immune Defic Syndr. 2000;23:81–8.
Jones CY, Hogan JW, Snyder B, et al. Overweight and human immunodeficiency virus (HIV) progression in women: associations HIV disease progression and changes in body mass index in women in the HIV epidemiology research study cohort. Clin Infect Dis. 2003;37(Suppl 2):S69–80. https://doi.org/10.1086/375889.
Amorosa V, Synnestvedt M, Gross R, et al. A tale of 2 epidemics: the intersection between obesity and HIV infection in Philadelphia. J Acquir Immune Defic Syndr. 2005;39:557–61.
Shuter J, Chang CJ, Klein RS. Prevalence and predictive value of overweight in an urban HIV care clinic. J Acquir Immune Defic Syndr. 2001;26:291–7.
Tang AM, Graham NM, Chandra RK, et al. Low serum vitamin B-12 concentrations are associated with faster human immunodeficiency virus type 1 (HIV-1) disease progression. J Nutr. 1997;127:345–51.
Fabre-Mersseman V, Tubiana R, Papagno L, et al. Vitamin D supplementation is associated with reduced immune activation levels in HIV-1-infected patients on suppressive antiretroviral therapy. AIDS. 2014;28:2677–82. https://doi.org/10.1097/QAD.0000000000000472.
Razonable R, Estes L, Thompson G. Gastric bypass surgery and serum concentrations of zidovudine, lamivudine, and nelfinavir. Present Int Conf AIDS. 2002;7-12:14.
NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956-61.
Frank E Harrell J Hmisc: Harrell Miscellaneous, 2015. R package version 3.17–0.
Sekhon JS Matching: multivariate and propensity score matching with balance optimization, 2013. R package version 48-3.4.
R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2015.
Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81. https://doi.org/10.1016/j.jbi.2008.08.010.
Brethauer SA, Kim J, Chaar M El, Papasavas P, Eisenberg D, Rogers A, Ballem N, Kligman M, Kothari S. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489–506. https://doi.org/10.1016/j.soard.2015.02.003
Fazylov R, Soto E, Merola S. Laparoscopic gastric bypass surgery in human immunodeficiency virus-infected patients. Surg Obes Relat Dis. 2007;3:637–9. https://doi.org/10.1016/j.soard.2007.08.012.
Muzard L, Alvarez J-C, Gbedo C, et al. Tenofovir pharmacokinetic after sleeve-gastrectomy in four severely obese patients living with HIV. Obes Res Clin Pract. 2017;11:108–13. https://doi.org/10.1016/j.orcp.2016.06.004.
Selke H, Norris S, Osterholzer D, et al. Bariatric surgery outcomes in HIV-infected subjects: a case series. AIDS Patient Care STDs. 2010;24:545–50. https://doi.org/10.1089/apc.2010.0132.
Zivich S, Cauterucci M, Allen S, et al. Long-term virologic outcomes following bariatric surgery in patients with HIV. Obes Res Clin Pract. 2015;9:633–5. https://doi.org/10.1016/j.orcp.2015.09.002.
Fysekidis M, Cohen R, Bekheit M, et al. 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. Obes Surg. 2015;25:229–33. https://doi.org/10.1007/s11695-014-1350-7.
Eddy F, Elvin S, Sanmani L. Bariatric surgery: an HIV-positive patient’s successful journey. Int J STD AIDS. 2016;27(1):70. https://doi.org/10.1177/0956462415571971.
Alfa-Wali M, Seechurn S, Ayodeji O, Nelson M, Shariq O, Milella M, Thompson J, Kapembwa M. Outcomes of bariatric surgery in human immunodeficiency virus positive individuals: a single center experience. Minerva Chir. 2016;71(4):233–8.
Crum-Cianflone NF, Roediger M, Eberly LE, et al. Obesity among HIV-infected persons: impact of weight on CD4 cell count. AIDS. 2010;24:1069–72. https://doi.org/10.1097/QAD.0b013e328337fe01.
Damouche A, Lazure T, Avettand-Fènoël V, et al. Adipose tissue is a neglected viral reservoir and an inflammatory site during chronic HIV and SIV infection. PLoS Pathog. 2015;11:e1005153. https://doi.org/10.1371/journal.ppat.1005153.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Gautam Sharma has no financial ties or financial disclosures pertinent to this work.
Andrew T Strong has no financial ties or financial disclosures pertinent to this work.
Mena Boules has no financial ties or financial disclosures pertinent to this work.
Chao Tu has no financial ties or financial disclosures pertinent to this work.
Samuel Szomstein has no financial ties or financial disclosures pertinent to this work.
Raul Rosenthal has no financial ties or financial disclosures pertinent to this work. He has received educational grant from Karl Storz, Medtronic, and Ethicon.
John Rodriguez has no financial ties or financial disclosures pertinent to this work. He has received research funding from Pacira Pharmaceuticals and Intuitive Surgical.
Alan Taege has no financial ties or financial disclosures pertinent to this work. He is a speaker for Gilead Sciences.
Matthew Kroh has no financial ties or financial disclosures pertinent to this work. He has serves as a consultant to Medtronic, Levita Magnetics, and Cook and has received research funding from Cook.
Ethical Approval Statement
For this type of study, formal consent is not required.
Informed Consent Statement
This study does not require informed consent.
Rights and permissions
About this article
Cite this article
Sharma, G., Strong, A.T., Boules, M. et al. Comparative Outcomes of Bariatric Surgery in Patients With and Without Human Immunodeficiency Virus. OBES SURG 28, 1070–1079 (2018). https://doi.org/10.1007/s11695-017-2996-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-017-2996-8