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EFFICACY AND SAFETY OF BARIATRIC SURGERY IN HIV-POSITIVE PATIENTS ON HIGHLY ACTIVE ANTIRETROVIRAL THERAPY
Varun Aitharaju
*1, Leandro Sierra
1, Ali Syed
2, Arjun Chatterjee
1, Akash Khurana
1, Roma Patel
1, Stephen A. Firkins
1, Rehan Haidry
3, Roberto Simons-Linares
11Cleveland Clinic, Cleveland, OH; 2University Hospitals, Cleveland, OH; 3Cleveland Clinic London Ltd, London, England, United Kingdom
Introduction: Obesity among people living with HIV (PLWH) is increasing. Bariatric procedures are effective in treating obesity among individuals without HIV. However, there are concerns that these surgeries in PLWH could reduce the absorption of highly active antiretroviral therapy (HAART), leading to poor clinical outcomes and reduced efficacy. While initial data suggests that bariatric surgery may be safe and beneficial for PLWH, large-scale studies are needed to confirm these findings.
Aim: This study aimed to compare mortality following bariatric surgery between PLWH on HAART and HIV-negative patients. Secondary aims included evaluating the incidence of adverse health outcomes commonly associated with bariatric surgery and assessing the surgery’s efficacy in this population by comparing changes in body mass index (BMI) postoperatively.
Methods: A retrospective analysis was conducted using the multi-institutional research network TriNetX that compiled data from 2004-2024. PLWH on HAART who underwent bariatric surgery (cases) were compared to a matched cohort of non-HIV patients who also underwent bariatric surgery (controls). The patients were propensity matched for age, gender, comorbidities, and BMI. Multivariable-adjusted Cox proportional hazards models were used to compare outcomes between cases and controls. BMI was evaluated during follow-up, between five and ten years after surgery.
Results: A total of 137,812 patients were included, of which 553 patients had HIV on HAART prior to undergoing bariatric surgery. After 1:1 propensity score matching, 550 patients were included in both cohorts. Five years following bariatric surgery, there was no difference in mortality (Hazard Ratio [HR] 0.83; 95% Confidence Interval [CI], 0.45-1.54) further shown in
Figure 1. There was also no difference in the incidence of inpatient admissions (HR 0.97; 95% CI, 0.80-1.19), acute kidney injury (HR 1.07; 95% CI, 0.74-1.55), sepsis (HR 1.01; 95% CI, 0.64-1.81), ileus (HR 0.86; 95% CI, 0.55-1.35), gastrointestinal (GI) bleeding (HR 0.96; 95% CI, 0.54-1.72), and thromboembolism (HR 1.34; 95% CI, 0.77-2.31). The mean BMI prior to surgery was 43.4 in both cohorts. Seventy patients in the PLWH cohort lacked BMI data following surgery. Among the remaining 480 patients in each cohort, no significant differences were identified in the prevalence of BMI 20–25 (p = 0.24), BMI >30 (p = 0.86), BMI >35 (p = 0.94), or BMI >40 (p = 0.16). Additional details are presented in
Table 1.
Conclusion: Among HIV-positive and HIV-negative patients, there was no significant difference in mortality, inpatient admission, or other adverse clinical outcomes associated with bariatric surgery. Bariatric surgery was also similarly effective in decreasing weight in both HIV-positive and HIV-negative patients.
Figure 1. Kaplan-Meier survival curves comparing PLWH and HIV-negative cohorts in the five years following bariatric surgery.
Table 1. Adverse clinical outcomes and efficacy of bariatric surgery in the study populations. Hazard ratios and p-values are reported for each clinical outcome. Efficacy analysis is based on BMI data collected 5–10 years post-surgery.
NA: Not applicable
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