Long-Term Virologic Outcomes Following Bariatric Surgery in HIV-Infected Patients
Steven Zivich(1), Margaret A. Cauterucci(2), Sara Allen(2), Marion Vetter(3), Christopher Vinnard(2)
(1) Department of Family Medicine, Drexel University College of Medicine, Philadelphia, PA (2)Division of Infectious Diseases & HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA (3) Bristol Myers Squibb, Lawrenceville, NJ
Introduction
 The prevalence of overweight/obesity among HIV-infected patients engaged in care in the U.S. is estimated to range between 30-40% overall.
 Surgical interventions for morbid obesity include restrictive procedures, such as adjustable gastric banding (AGB) and sleeve gastrectomy (SG),
and gastrointestinal diversionary procedures, such as Roux-en-Y gastric bypass (RYGB) (2).
 Prior case series of HIV-infected patients undergoing bariatric procedures have demonstrated virologic efficacy of ART in the immediate postoperative period(7), and a single case series that included 6 patients receiving ART reported continued virologic efficacy after a median of 16
months follow-up time(7)
 The overall objective of this work is to develop a novel diagnostic approach to identify TB patients with low anti-TB drug bioavailability, which could
be used to optimize anti-TB drug dosing in resource-limited settings.
 Our objective was to assess the long-term durability of ART regimens among HIV-infected patients undergoing bariatric procedures for the
management of obesity and related conditions, in order to test the hypothesis that bariatric procedures would be associated with sustained
virologic efficacy.
Results
Table 1: Subjects’ Demographics
Table 2: Metabolic Measures of Subjects Pre- and Post- Procedure
Objective
 Our objective was to assess the long-term durability of ART regimens among HIV-infected patients undergoing bariatric procedures
for the management of obesity and related conditions, in order to test the hypothesis that bariatric procedures would be associated
with sustained virologic efficacy.
Hypothesis
Figure 2: HIV Viral Load Over Time
 We hypothesized that bariatric procedures in HIV-infected patients would be associated with sustained long-term virologic efficacy
and durability.
Methods
Figure 1: BMI Changes Over Time
 We performed a retrospective cohort study of HIV-infected patients who underwent bariatric surgery between the January 1, 2005, and July 1,
2014 while receiving care at the Partnership Comprehensive Care Practice (PCCP), a multidisciplinary HIV clinic affiliated with Drexel University
College of Medicine.
 Patients were identified from the records of the clinic nutritionist, who is required to evaluate all patients prior to scheduling a bariatric procedure.
 The proportion of HIV viral load measurements that were undetectable before and after the bariatric procedure were compared to determine the
effect of bariatric surgery on virologic efficacy. This approach allowed each patient to serve as their own control.
 In secondary analyses, we examined changes in CD4+ T cell count, HbA1c, LDL, HDL, triglycerides, and blood pressure using within subject
analysis of variance (ANOVA) for repeated measures.
 Statistical significance was declared for p-values less than 0.05. The Institutional Review Board at Drexel University College of Medicine approved
the study.
References
 Keithley JK, Duloy AM, Swanson B, Zeller JM. HIV infection and obesity: a review of the evidence. J Assoc Nurses AIDS Care 2009; 20(4):260-74.
 Gloy VL, Briel M, Bhatt DL, et al. Bariatrc surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomized controlled trials. BMJ 2013;
347:f5934.
 Razonable R, Estes L, Thompson G. Gastric bypass surgery and serum concentrations of zidovudine, lamivudine, and nelfinavir. Presented at the International Conference on AIDS,
July 7-12, 2002, p. 14.
 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 2014. DOI 10.1007.
Conclusions
 All three bariatric surgery procedures were safe among morbidly obese HIV-infected
patients in our clinic population, with regards to preserved virologic efficacy.
 Gastric banding was least effective with regards to weight loss.
 As more HIV-infected patients undergo these interventions, prospective studies will
be required to determine whether bariatric procedures lead to changes in the
gastrointestinal absorption and oral bioavailability of individual medications in ART
regimens.