Bariatric surgery in HIV patients: experience of an Obesity Reference Center in France

Abstract Background Few data on bariatric surgery are available regarding obese human immunodeficiency virus (HIV)-infected patients. Settings Antoine Beclere hospital, Clamart, Paris-sud University, France Methods Prospective observational follow-up study recruited HIV-infected patients who underwent bariatric surgery from 2009 to 2015. Baseline demographic characteristics, surgery characteristics, perioperative outcomes, changes in weight loss, HIV markers, antiretroviral drug plasma levels are described. Results There were 10 patients followed before and after sleeve gastrectomy: 2 men and 8 women; 50% of African origin; median age, 48.5 years, median time since HIV infection, 7.5 years; median body mass index, 48.5 kg/m 2 . Of patients, 8 had co-morbidities. All except 2 patients received antiretroviral drugs at the time of surgery with a median CD4 cell count at 709/mm 3 . There was no death or postoperative infectious complications. The median follow-up was 18 months (range, 15–55). The median postoperative weight loss was 43 kg (range, 17–83). Median percentage of excess weight loss was 82.5% (range, 35–119) at the latest visit after surgery. All co-morbidities were resolutive with weight loss. We observed no significant modification of CD4 cell count before and after surgery. Pharmacokinetics of antiretroviral drugs remains adequate and efficacious. Conclusion Our prospective series is the largest one on sleeve gastrectomy procedures performed on obese-treated HIV-infected patients. The sleeve generates good results in weight loss, with no significant impact on HIV infection, and with improvement of obesity-associated co-morbidities. Optimal management of HIV-infected patients with morbid obesity may include classical surgical procedures.