I started a combination therapy of Reyataz, Norvir, and Truvada in mid August of 2007. Since being on the meds my cholesterol has gone from 159 to 209, My blood sugar hovers at an average of 177, and my liver levels are slightly elevated. My T-Cells are around 350 and my viral load is undetectable.

I ended up checking into the hospital the week before Christmas due to pneumococcal pneumonia and while in the hospital my blood sugar elevated to 500 at one point and I was kept a few extra days to get that under control. I was also visited by a liver doctor who mentioned a condition called NASH that I should be concerned about. I weigh about 375 and I am 6'4" tall. I am starting to consider the Lap band procedure to get my weight under control since I have been unable to long term commit to the life change needed for natural weight loss. I am now at the point where I am considering the Lap band procedure... and here is my delima.

One, I know that a lot of doctors will not perform the procedure on someone who is HIV positive because of fear of the disease itself. When I brought this up to my HIV doctor he suggested that I don't even bring up my HIV status since it is extremely important for me to get my weight under control because of my health reasons. He actually said my weight is more of a threat to my body than HIV.

Two, If I do not tell the doctor doing the procedure then I see two problems, the first is how am I going to continue Norvir if I can only be on a liquid diet at first, and second, isn't it ethically wrong not to tell an operating physician that you have an infection that is blood contained. Are surgeons "more careful" if they know you are positive?

The most important issue you raise is an ethical one, and I agree with you that your HIV status needs to be discussed with the prospective surgeon. This information is highly confidential within your medical records, so you should not have any concerns in this regard. Beyond this, there is no "sepcial care" taken by the surgeons during the operation, as universal precautions are followed. However, if an accident occurs, the knowledge of your status will allow for the person exposed to your blood to receive PEP immediately. Beyond this point, I agree that all of the problems you describe relate to your weight rather than the HIV infection. This applies to the NASH, diabetes, cholesterol and even the pneumonia. Taking care of your weight is a priority. Surgery is a real option, as long as you have considered all else that is available short of this. As for your antivirals, many are available in liquid form, and you can either switch to those before the surgery to make sure they work for you, or consider staying on your current meds and going off them for a few days around the time of your surgery. Discuss what is best to do with your doctor.