Obesity Surgery

, Volume 28, Issue 8, pp 2550–2559 | Cite as

The Effect of Bariatric Surgery on Patients with HIV Infection: a Literature Review

  • Khalid Akbari
  • Robin Som
  • Marianne Sampson
  • Syed Hussain Abbas
  • James Ramus
  • Greg Jones
Review Article


Obesity among human immunodeficiency virus (HIV)-infected individuals is on the rise. Bariatric procedures such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) alter the GI tract. Whether this alteration has any impact on the absorption of highly active antiretroviral therapy (HAART), thus affecting HIV disease markers such as CD4 cell count or viral load (VL), is not yet known. We conducted this review to look into the outcomes of bariatric surgery procedures, RYGB, SG and adjustable gastric band (AGB) and its effects on the CD4 cell counts and VL and HAART therapy. A literature search was conducted between January and April 2017, by two independent reviewers, using Pubmed and Google Scholar. The terms ‘bariatric surgery and HIV’, ‘obesity surgery and HIV’, ‘gastric bypass surgery and HIV’, ‘sleeve gastrectomy and HIV’ and ‘gastric band and HIV’ were used to retrieve available research. Of the 49 papers reviewed, only 12 reported the outcomes of patients with HIV undergoing bariatric surgery and were therefore included in this review. Six papers assessed patients undergoing RYGB only (N = 18), 3 papers reported on SG only (N = 18) and 3 papers reported on case mix, including 7 cases of RYGB, 4 cases of SG and 11 cases of AGB. Data is limited; however, based on the available data, bariatric surgery is safe in HIV-infected individuals and does not have any adverse impact on HIV disease progress. Additionally, there was no difference in HIV-related outcomes between SG and RYGB.


Obesity in HIV Bariatric surgery in HIV Bariatric outcomes in HIV Roux-en-Y bypass in HIV Sleeve gastrectomy in HIV Gastric band in HIV Bariatric surgery safety in HIV 


Compliance with Ethical Standards

Formal consent and ethical approval is not required for this type of study.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Public Health England. April 2013. Available online at:
  2. 2.
    Tate T, Willing AL, Willing JH, et al. HIV infection and obesity: where did all the wasting go? Antivir Ther. 2012;17(7):1281–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Mahy M, Stover J, Stanecki K, et al. Estimating the impact of antiretroviral therapy: regional and global estimates of life-years gained among adults. J Sex Transm Dis. 2010;86:ii67–71.Google Scholar
  4. 4.
    Seecheran VK, Giddings SL, Seecheran NA. Acute coronary syndromes in patients with HIV. Coron Artery Dis. 2017;28(2):166–72.CrossRefPubMedGoogle Scholar
  5. 5.
    Grinspoon S, Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med. 2005;352(1):48–62.CrossRefPubMedGoogle Scholar
  6. 6.
    Timmons T, Shen C, Aldrovandi G, et al. Microbial translocation and metabolic and body composition measures in treated and untreated HIV infection. AIDS Res Hum Retrovir. 2014;30(3):272–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Fernandez-Real JM, Broch M, Richart C, et al. CD14 monocyte receptor, involved in the inflammatory cascade, and insulin sensitivity. J Clin Endocrinol Metab. 2003;88(4):1780–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Anuurad E, Bremer A, Berglund L. HIV protease inhibitors and obesity. Curr Opin Endocrinol Diabetes Obes. 2010;17(5):478–85.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hollanda A, Ruiz T, Jimenez A, et al. Patterns of weight loss response following gastric bypass and sleeve gastrectomy. Obes Surg. 2015;25(7):1177–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.CrossRefPubMedGoogle Scholar
  11. 11.
    Silecchia G, Bacci V, Bacci S, et al. Reoperation after laparoscopic adjustable gastric banding: analysis of a cohort of 500 patients with long-term follow-up. Surg Obes Relat Dis. 2008;4:430–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Li J-F, Lai D-D, Ni B, et al. Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Can J Surg. 2013;56(6):E158–64.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.CrossRefPubMedGoogle Scholar
  14. 14.
    MacBrayne CE, Blum JD, Kiser JJ. Tenofovir, emtricitabine, and darunavir/ritonavir pharmacokinetics in an HIV-infected patient after Roux-en-Y gastric bypass surgery. Ann Pharmacother. 2014;48(6):816–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Michalik DE, Jackson-Alvarez JT, Flores R, et al. Low third-trimester serum levels of lamivudine/zidovudine and lopinavir/ritonavir in an HIV-infected pregnant woman with gastric bypass. J Int Assoc Provid AIDS Care. 2015;14(2):116–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Alfa-Wali M, Seechurn S, Ayodeji O, et al. Outcomes of bariatric surgery in human immunodeficiency virus positive individuals: a single center experience. Minerva Chir. 2016;71(4):233–8.PubMedGoogle Scholar
  17. 17.
    Seechurn S, Alfa-Wali M, Ayodeji O, et al. Obesity and HIV infection-is there a role for bariatric surgery in treatment? J AIDS Clin Res. 2014;5:402.Google Scholar
  18. 18.
    Fazylov R, Soto E, Merola S. Laparoscopic gastric bypass surgery in human immunodeficiency virus-infected patients. Surg Obes Relat Dis. 2007;3(6):637–9.CrossRefPubMedGoogle Scholar
  19. 19.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Flanchbaum L, Drake V, Colarusso T, et al. Initial experience with bariatric surgery in asymptomatic human immunodeficiency virus-infected patients. Surg Obes Relat Dis. 2015;1(2):73–6.CrossRefGoogle Scholar
  21. 21.
    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.CrossRefPubMedGoogle Scholar
  22. 22.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. J Am Med Assoc. 2004;292:1724–37.CrossRefGoogle Scholar
  23. 23.
    Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the diabetes surgery study randomized clinical trial. JAMA. 2013;309:2240–9.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Dixon JB, O’Brien PE. Lipid profile in the severely obese: changes with weight loss after lap-band surgery. Obes Res. 2002;10:903–10.CrossRefPubMedGoogle Scholar
  25. 25.
    Tran HS, Moncure M, Tarnoff M, et al. Predictors of operative outcome in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Am J Surg. 2000;180(3):228–33.CrossRefPubMedGoogle Scholar
  26. 26.
    Xia XJ, Liu BC, Su JS, et al. Preoperative CD4 count or CD4/CD8 ratio as a useful indicator for postoperative sepsis in HIV-infected patients undergoing abdominal operations. J Surg Res. 2012;174(1):e25–30.CrossRefPubMedGoogle Scholar
  27. 27.
    Saltzman DJ, Williams RA, Gelfand DV, et al. The surgeon and AIDS: twenty years later. Arch Surg. 2005;140(10):961–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Chichom-Mefire A, Azabji-Kenfack M, Atashili J. CD4 count is still a valid Indicator of outcome in HIV-infected patients undergoing major abdominal surgery in the era of highly active antiretroviral therapy. World J Surg. 2015;39(7):1692–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Patrick L. Nutrients and HIV: part two--vitamins a and E, zinc, B-vitamins, and magnesium. Altern Med Rev. 2000;5(1):39–51.PubMedGoogle Scholar
  30. 30.
    Baum MK, Shor-Posner G, Lu Y, et al. Micronutrients and HIV-1 disease progression. AIDS. 1995;9(9):1051–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Eddy F, Elvin S, Sanmani L. Bariatric surgery: an HIV-positive patient’s successful journey. Int J STD AIDS. 2015. Online first.Google Scholar
  32. 32.
    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(2):229–33.CrossRefPubMedGoogle Scholar
  33. 33.
    Pourcher G, Costagliola D, Martinez V. Obesity in HIV-infected patients in France: prevalence and surgical treatment options. J Visc Surg. 2015;152(1):33–7.CrossRefPubMedGoogle Scholar
  34. 34.
    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. 2016;11(1):108–13.CrossRefPubMedGoogle Scholar
  35. 35.
    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319–24.CrossRefPubMedGoogle Scholar
  36. 36.
    DeMaria EJ, Sugerman HJ, Meador JG, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001;233(6):809–18.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Himpens J, Cadière G-B, Bazi M, et al. Long-term outcomes of laparoscopic adjustable gastric banding. Arch Surg. 2011;146(7):802–7.CrossRefPubMedGoogle Scholar
  38. 38.
    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.CrossRefPubMedGoogle Scholar
  39. 39.
    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.CrossRefPubMedGoogle Scholar
  40. 40.
    Matarese G. Leptin and the immune system: how nutritional status influences the immune response. Eur Cytokine Netw. 2000;11:7–14.PubMedGoogle Scholar
  41. 41.
    Koethe JR, Jenkins CA, Shepherd BE, et al. An optimal body mass index range associated with improved immune reconstitution among HIV-infected adults initiating antiretroviral therapy. Clin Infect Dis. 2011;53(9):952–60.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Aman MW, Stem M, Schweitzer MA, et al. Early hospital readmission after bariatric surgery. Surg Endosc 2016;30(6):2231–8.Google Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Oxford School of SurgeryRoyal Berkshire HospitalReadingUK
  2. 2.Department of Upper GI and Minimal Access SurgeryKing’s College HospitalLondonUK
  3. 3.Royal Berkshire HospitalReadingUK

Personalised recommendations