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Comparative Outcomes of Bariatric Surgery in Patients With and Without Human Immunodeficiency Virus

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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.

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Authors and Affiliations

  1. Section of Surgical Endoscopy, Cleveland Clinic, Digestive Disease and Surgery Institute, Cleveland, OH, USA

    Gautam Sharma, Andrew T. Strong, Mena Boules, Chao Tu, John Rodriguez & Matthew Kroh

  2. Quantitiatve Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Chao Tu

  3. Bariatric and Metabolic Institute, Cleveland Clinic, Tampa, Florida, USA

    Samuel Szomstein & Raul Rosenthal

  4. Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Samuel Szomstein, Raul Rosenthal, John Rodriguez, Alan J. Taege & Matthew Kroh

  5. Infectious Disease Institute, Cleveland Clinic, Cleveland, OH, USA

    Alan J. Taege

  6. Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates

    Matthew Kroh

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  1. Gautam Sharma
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Correspondence to Matthew Kroh.

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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.

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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

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