Obesity Surgery

, Volume 28, Issue 4, pp 1070–1079 | Cite as

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

  • Gautam Sharma
  • Andrew T. Strong
  • Mena Boules
  • Chao Tu
  • Samuel Szomstein
  • Raul Rosenthal
  • John Rodriguez
  • Alan J. Taege
  • Matthew Kroh
Original Contributions
  • 130 Downloads

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.

Keywords

Bariatric surgery Human immunodeficiency virus Roux-en-Y gastric bypass Sleeve gastrectomy Viral load CD4 count Bariatric complications 

Notes

Compliance with Ethical Standards

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.

References

  1. 1.
    Hogg RS, Heath KV, Yip B, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279:450–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Palella FJ, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med. 1998;338:853–60.  https://doi.org/10.1056/NEJM199803263381301.CrossRefPubMedGoogle Scholar
  3. 3.
    Enanoria WT, Ng C, Saha SR, et al. Treatment outcomes after highly active antiretroviral therapy: a meta-analysis of randomised controlled trials. Lancet Infect Dis. 2004;4:414–25.  https://doi.org/10.1016/S1473-3099(04)01057-6.CrossRefPubMedGoogle Scholar
  4. 4.
    Keithley JK, Duloy AMS, Swanson B, et al. HIV infection and obesity: a review of the evidence. J Assoc Nurses AIDS Care. 2009;20:260–74.  https://doi.org/10.1016/j.jana.2009.02.006.CrossRefPubMedGoogle Scholar
  5. 5.
    Shikuma CM, Zackin R, Sattler F, et al. Changes in weight and lean body mass during highly active antiretroviral therapy. Clin Infect Dis. 2004;39:1223–30.  https://doi.org/10.1086/424665.CrossRefPubMedGoogle Scholar
  6. 6.
    Montessori V, Press N, Harris M, et al. Adverse effects of antiretroviral therapy for HIV infection. CMAJ. 2004;170:229–38.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Henry K, Melroe H, Huebsch J, et al. Severe premature coronary artery disease with protease inhibitors. Lancet. 1998;351:1328.  https://doi.org/10.1016/S0140-6736(05)79053-X.CrossRefPubMedGoogle Scholar
  8. 8.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376:641–51.  https://doi.org/10.1056/NEJMoa1600869.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Flancbaum L, Drake V, Colarusso T, et al. Initial experience with bariatric surgery in asymptomatic human immunodeficiency virus-infected patients. Surg Obes Relat Dis. 1:73–6.  https://doi.org/10.1016/j.soard.2005.02.004.
  10. 10.
    Shor-Posner G, Campa A, Zhang G, et al. When obesity is desirable: a longitudinal study of the Miami HIV-1-infected drug abusers (MIDAS) cohort. J Acquir Immune Defic Syndr. 2000;23:81–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Jones CY, Hogan JW, Snyder B, et al. Overweight and human immunodeficiency virus (HIV) progression in women: associations HIV disease progression and changes in body mass index in women in the HIV epidemiology research study cohort. Clin Infect Dis. 2003;37(Suppl 2):S69–80.  https://doi.org/10.1086/375889.CrossRefPubMedGoogle Scholar
  12. 12.
    Amorosa V, Synnestvedt M, Gross R, et al. A tale of 2 epidemics: the intersection between obesity and HIV infection in Philadelphia. J Acquir Immune Defic Syndr. 2005;39:557–61.PubMedGoogle Scholar
  13. 13.
    Shuter J, Chang CJ, Klein RS. Prevalence and predictive value of overweight in an urban HIV care clinic. J Acquir Immune Defic Syndr. 2001;26:291–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Tang AM, Graham NM, Chandra RK, et al. Low serum vitamin B-12 concentrations are associated with faster human immunodeficiency virus type 1 (HIV-1) disease progression. J Nutr. 1997;127:345–51.CrossRefPubMedGoogle Scholar
  15. 15.
    Fabre-Mersseman V, Tubiana R, Papagno L, et al. Vitamin D supplementation is associated with reduced immune activation levels in HIV-1-infected patients on suppressive antiretroviral therapy. AIDS. 2014;28:2677–82.  https://doi.org/10.1097/QAD.0000000000000472.CrossRefPubMedGoogle Scholar
  16. 16.
    Razonable R, Estes L, Thompson G. Gastric bypass surgery and serum concentrations of zidovudine, lamivudine, and nelfinavir. Present Int Conf AIDS. 2002;7-12:14.Google Scholar
  17. 17.
    NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956-61.Google Scholar
  18. 18.
    Frank E Harrell J Hmisc: Harrell Miscellaneous, 2015. R package version 3.17–0.Google Scholar
  19. 19.
    Sekhon JS Matching: multivariate and propensity score matching with balance optimization, 2013. R package version 48-3.4.Google Scholar
  20. 20.
    R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2015.Google Scholar
  21. 21.
    Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.  https://doi.org/10.1016/j.jbi.2008.08.010.CrossRefPubMedGoogle Scholar
  22. 22.
    Brethauer SA, Kim J, Chaar M El, Papasavas P, Eisenberg D, Rogers A, Ballem N, Kligman M, Kothari S. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489–506.  https://doi.org/10.1016/j.soard.2015.02.003
  23. 23.
    Fazylov R, Soto E, Merola S. Laparoscopic gastric bypass surgery in human immunodeficiency virus-infected patients. Surg Obes Relat Dis. 2007;3:637–9.  https://doi.org/10.1016/j.soard.2007.08.012.CrossRefPubMedGoogle Scholar
  24. 24.
    Muzard L, Alvarez J-C, Gbedo C, et al. Tenofovir pharmacokinetic after sleeve-gastrectomy in four severely obese patients living with HIV. Obes Res Clin Pract. 2017;11:108–13.  https://doi.org/10.1016/j.orcp.2016.06.004.CrossRefPubMedGoogle Scholar
  25. 25.
    Selke H, Norris S, Osterholzer D, et al. Bariatric surgery outcomes in HIV-infected subjects: a case series. AIDS Patient Care STDs. 2010;24:545–50.  https://doi.org/10.1089/apc.2010.0132.CrossRefPubMedGoogle Scholar
  26. 26.
    Zivich S, Cauterucci M, Allen S, et al. Long-term virologic outcomes following bariatric surgery in patients with HIV. Obes Res Clin Pract. 2015;9:633–5.  https://doi.org/10.1016/j.orcp.2015.09.002.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    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. 2015;25:229–33.  https://doi.org/10.1007/s11695-014-1350-7.CrossRefPubMedGoogle Scholar
  28. 28.
    Eddy F, Elvin S, Sanmani L. Bariatric surgery: an HIV-positive patient’s successful journey. Int J STD AIDS. 2016;27(1):70.  https://doi.org/10.1177/0956462415571971.CrossRefPubMedGoogle Scholar
  29. 29.
    Alfa-Wali M, Seechurn S, Ayodeji O, Nelson M, Shariq O, Milella M, Thompson J, Kapembwa M. Outcomes of bariatric surgery in human immunodeficiency virus positive individuals: a single center experience. Minerva Chir. 2016;71(4):233–8.Google Scholar
  30. 30.
    Crum-Cianflone NF, Roediger M, Eberly LE, et al. Obesity among HIV-infected persons: impact of weight on CD4 cell count. AIDS. 2010;24:1069–72.  https://doi.org/10.1097/QAD.0b013e328337fe01.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Damouche A, Lazure T, Avettand-Fènoël V, et al. Adipose tissue is a neglected viral reservoir and an inflammatory site during chronic HIV and SIV infection. PLoS Pathog. 2015;11:e1005153.  https://doi.org/10.1371/journal.ppat.1005153.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Section of Surgical Endoscopy, Cleveland ClinicDigestive Disease and Surgery InstituteClevelandUSA
  2. 2.Quantitiatve Health SciencesCleveland ClinicClevelandUSA
  3. 3.Bariatric and Metabolic InstituteCleveland ClinicFloridaUSA
  4. 4.Lerner College of MedicineCase Western Reserve UniversityClevelandUSA
  5. 5.Infectious Disease InstituteCleveland ClinicClevelandUSA
  6. 6.Digestive Disease Institute, Cleveland ClinicAbu DhabiUnited Arab Emirates

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