Bariatric surgery suitable for people with HIV and obesity

Some people with HIV are obese as well. Researchers from the Radboudumc and Dutch colleagues analyzed whether bariatric surgery could be a suitable procedure for weight loss. In general, it’s an effective intervention, they conclude in an article in Clinical Infectious Diseases.

Despite HIV (viral infection that causes AIDS) always being seen as a “slim” disease, people with HIV can get obesity similar to those with no infection. The percentage of men with HIV and obesity is almost the same as the overall figure for Dutch men (11.6% - 12.3%), while obesity in women with HIV (31.7%) is almost doubled compared to Dutch women in general (15.4%). Being obese can be alarming because people with HIV and overweight generally have a higher risk of developing diseases such as diabetes and high blood pressure than people with obesity but no HIV. In addition to sedentary lifestyle and high-fat diet, HIV drugs (antiretrovirals) may also play a role in the development of obesity and metabolic disease in people with HIV.

Obesity treatment in people with HIV
If lifestyle and diet changes do not result in sufficient weight loss, bariatric surgery is an option. This procedure involves reducing the stomach and/or the intestine size to restrict food intake. Often, bariatric surgery leads to an improvement in overall health and less diseases associated with obesity. But does bariatric surgery work in people with HIV as well despite the high risk of diseases? Do these significant changes in the digestive system affect the activity of HIV drugs that are essential for the viral control in this population?

Effect of bariatric surgery on HIV
This topic was investigated by Leena Zino, David Burger and Angela Colbers of Radboudumc and their Dutch colleagues. Zino, affiliated with the Department of Pharmacy: "Due to the high risk of developing obesity and the associated comorbidities in people with HIV, it is unknown if this population would benefit from surgery. Additionally, bariatric surgery significantly changes the anatomy of the gastrointestinal tract. This can affect the metabolism and absorption of medications, thereby affecting the type and dosage of HIV medications. Little research is done on the latter, and most of this research is into older antiretroviral drugs. We wanted to know whether this surgical intervention had an effect on weight loss, obesity disease and HIV virus control in people with HIV. We started to investigate this in the pre-existing national ATHENA cohort of people living with HIV."

Weight loss and less medication intake
The (retrospective) study therefore looked at the response of the HIV control with different antiretroviral therapy (ART) regimens, and whether weight loss was sufficient in this population; both up to 18 months after bariatric surgery. Data from fifty-one individuals from all Dutch HIV clinics were analyzed in this study.
"In three individuals, we saw a temporary dip in suppressing the virus," says Zino, "and in only one individual did the usual antiviral regimen no longer prove sufficient to keep the virus down. That incidence is commonly seen in people with HIV meaning there was no worsening in HIV control after surgery."

Effective intervention
After a year and a half, eighty-five percent of the people had at least 20 percent weight loss, which is considered successful in the clinical guidelines of the surgery. Furthermore, the researchers saw a markedly improved lipid profile in most people which means a better metabolic profile. After bariatric surgery, the number of medications taken by the people with HIV dropped markedly by half. The number of obesity-related medications decreased also by almost two thirds, from 62 to 25 in the full  study group.
Zino: "Thus, based on these results, bariatric surgery is indeed an effective intervention for people with HIV and obesity. Although some therapeutic considerations are very important in people with HIV undergoing bariatric surgery to ensure an optimal HIV control, we are now more confident about the positive effect of this surgery in people with HIV and obesity.“
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Paper in Clinical Infectious Diseases: Outcomes of bariatric surgery in people with HIV: a retrospective analysis from ATHENA cohort - Leena Zino, Ferdinand Wit, Casper Rokx, Jan G den Hollander, Mark van der Valk, Olivier Richel, David M Burger, Angela Colbers 

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