gastric bypass / HIV / impact on treatment / safety

Question

Hi There! I've been an on/off visitor of thebody.com for many years - you guys helped me put HIV in perspective. 40 years old now, HIV+ for 15, and doing great with undetectable viral loads ever since starting treatment (first on kaletra/truvada, then reyataz/norvir/truvada, then Atripla, now Tivicay/Truvada).

In the last decade or so, my body weight has been increasing steadily in spite of efforts to limit my weight. I'm now at 120kg/186cm hight, I have no cholesterol issues, but a documented insulin resistance for which I'm supposed to take metformin.

I'm now investigating the possibility to get a gastric bypass - Health care here in Belgium is excellent, and most likely I'll fit the vaguely spheroid bill to get the surgery free of charge.

I value the expert opinion of my health care professionals greatly (being a microbiologist myself), but would like to know if anno 2017 (best wishes!) there is a consensus on Gastric Bypasses in HIV+ people - safety, drug absorption kinetic issues, ...? I found some articles online, some quite old (2004).

Many thanks, P

Answer

Hello and thanks for posting.

Obesity is increasingly an issue for people living with HIV, just as it is for the general population, defined by having a body mass index (BMI) >25 kg/m2 (for most ethnic groups). While diet, exercise and other behavioral interventions definitely help, for some people, genetics and other medical factors simply make it difficult to lose weight. The American Association of Clinical Endocrinology has published comprehensive guidelines for the management of obesity. The guidelines note the need to screen for important medical complications (like hypertension, diabetes, sleep apnea or low testosterone, among many others); dietary and lifestyle interventions, and indications for a set of prescription medications that can be used for certain individuals.

Regarding bariatric (weight-loss) surgery, the guidelines recommend "patients with a BMI of ≥40 kg/m2 without coexisting medical problems and for whom the procedure would not be associated with excessive risk should be eligible for bariatric surgery".

There have been a few publications reporting positive results of bariatric surgery among people living with HIV, a quick search of the Public Library of Medicine (PubMed), yielded recent reports of small case series from London, Philadelphia and Colorado. The later also reports that adequate HIV drug levels (to tenofovir, FTC and darunavir) were maintained after the surgery.

In our own clinic, several patients have successfully undergone weight reduction surgery, with continuation of viral suppression, loss of weight and improvement in their secondary medical complications (like hypertension and diabetes).

I hope that's helpful P. Stay in touch and let us know how your case turns out. BY