Background

Metabolic bariatric surgery (MBS), including laparoscopic sleeve gastrectomy (LSG), increases stomach pH and reduces gastric mixing, diminishing drug disintegration. This may affect antiretroviral pharmacokinetics, resulting in treatment failure and drug resistance in HIV-positive patients on antiretroviral therapy (ART). This study investigates the relationship between MBS and HIV-related laboratory parameters.

Methods

Single-center retrospective study of virologically suppressed (VS) HIV-positive patients on ART who underwent LSG between October 2014-2023. Parameters analyzed: viral load (VL); CD4; CD4/CD8 ratio, collected per usual clinical care; and ART.

Results

Sample: 10 HIV-positive patients VS on ART (mean age 46.2+-10.3 years, 70% female, 80% African-American, median BMI (kg/m2) 46.2 [38.8-51.0]). Time followedmedian 42 [15-70] weeks post-LSG. All patients remained VS at first post-LSG measurement (median 2.5 [1-4.5] months). Breakthrough VL (> 50 copies/mL) was seen in 2 patients, but viral suppression was restored without ART changes. All patients remained VS at last follow-up measurement. Median CD4 (cells cu/mm) was 786 [524-1186] preoperatively, decreased within 6 months postoperatively (637 [316-954], S=-10.5, p=0.03), but returned to baseline within 12 months (762 [635-1088], S=2.0, p=0.81). Median CD4/CD8 ratio was 0.83 [0.51-1.11] preoperatively and remained stable postoperatively (12 months, 0.89 [0.65-1.1], S=4.0, p=0.71).

Conclusions

MBS did not affect VL or ART efficacy. Throughout follow-up, 8 of 10 medication-compliant patients remained VS. All patients regained VS by last follow-up without ART changes. CD4 and CD4/CD8 ratio remained stable within 12 months. LSG for treatment of obesity and comorbidities in HIV-positive patients is safe and does not jeopardize ART-mediated viral suppression.