Initial experience with bariatric surgery in asymptomatic human immunodeficiency virus-infected patients

Abstract

Background: Performance of bariatric surgery in patients with human immunodeficiency virus (HIV) infection is controversial. The advent of highly active antiretroviral treatment (HAART) has dramatically reduced the progression of HIV/AIDS, so that these individuals live longer, with nearly undetectable viral loads, and thus may develop obesity and similar obesity-related comorbidity as occurs in the general population. However, HAART also causes lipodystrophy, placing these patients at increased risk for coronary artery disease.

Methods: This was a retrospective study of 6 patients from a prospectively maintained database of 892 patients (0.71%) undergoing bariatric surgery between June 1999 and December 2003.

Results: Six HIV-infected patients (4 women, 2 men; mean age, 43 years [range, 28-56 years]; mean preoperative weight, 142 kg [range, 110-174 kg]; mean preoperative body mass index, 50 [range, 42-59) underwent Roux-en-Y gastric bypass (RYGB). The mean duration of HIV infection was 9 years; 33% were receiving HAART at the time of surgery, which was discontinued perioperatively for 2-3 days. Average CD4 cell count was 619 cells/mm3 (range, 361-1096 cells/mm3). Preoperative comorbidities included type 2 diabetes mellitus/impaired glucose tolerance (3 cases), hypertension (2 cases), dyslipidemia (2 cases), coronary artery disease/chronic heart failure (1 case), sleep apnea (4 cases), asthma (2 cases), gastroesophageal reflux disease (3 cases), arthritis (5 cases), and depression (3 cases). Average preoperative length of hospital stay was 4.2 days (range, 3-5 days). There were no deaths or postoperative infectious complications. Mean percent excess body weight loss was 33% at 3 months, 47% at 6 months, and 61% at 12 months. Mean percent initial body weight lost was 19% at 3 months, 26% at 6 months, and 33% at 12 months.

Conclusion: RYGB can be safely performed in HIV-infected individuals. Initial results appear to be comparable to those in noninfected controls. Well-controlled HIV infection should not be an absolute contraindication to bariatric surgery.