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Bariatric surgery and HIV: Joint venture between family, primary care, and HIV physicians

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Title: Bariatric surgery and HIV: Joint venture between family, primary care, and HIV physicians
Authors: Ceren Aydemir, Raniah Al Saidi, Ji Soo Choi, Mohamed H. Ahmed, Dushyant Mital
Source: Journal of Family Medicine and Primary Care, Vol 13, Iss 12, Pp 5920-5923 (2024)
Publisher Information: Wolters Kluwer Medknow Publications, 2024.
Publication Year: 2024
Collection: LCC:Medicine
Subject Terms: bariatric surgery, diabetes, hiv, obesity, Medicine
More Details: We report a case of a 49-year-old female with a history of HIV infection for 12 years. The patient had excellent compliance with antiretroviral medications, raltegravir 400 mg twice daily and truvada once daily for HIV. Over the years, she maintained an undetectable viral load with a CD4+ count >200 cells/μL. She has a history of type II diabetes, hypertension, bipolar manic depression, endometriosis, recurrent herpes simplex attacks, arthritis in both shoulders, irritable bowel syndrome (IBS), and nonalcoholic fatty liver disease (NAFLD). She weighed 148 kg with a body mass index (BMI) of 52.08 kg/m2. Her medication included diltiazem 60 mg once a day, glyceryl trinitrate (GTN) spray, metformin 1 g twice daily, and linagliptin 500 mg once daily for her type II diabetes with glycated hemoglobin (HbA1c) of 8.4%. She has full capacity and elected to have bariatric surgery; 4 months postprocedure, she lost 28 kg with a reduced BMI of 38.62 kg/m2 with no postoperative complications. Her diabetes control improved, and she no longer required linagliptin and metformin. Following the procedure, she was given supplements including ferrous sulfate, vitamin B12, vitamin D, and calcium. She was also prescribed lansoprazole. The case illustrates that bariatric surgery is an effective and safe operation for people living with HIV. Due to complex needs and the need for regular follow-up; primary care, family, and HIV physicians can all collaborate in the care of individuals living with HIV and who underwent bariatric surgery.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 2249-4863
2278-7135
Relation: https://journals.lww.com/10.4103/jfmpc.jfmpc_730_24; https://doaj.org/toc/2249-4863; https://doaj.org/toc/2278-7135
DOI: 10.4103/jfmpc.jfmpc_730_24
Access URL: https://doaj.org/article/0889a14e001e447f994d2eaeda9151f2
Accession Number: edsdoj.0889a14e001e447f994d2eaeda9151f2
Database: Directory of Open Access Journals
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  Value: <anid>AN0181498508;[fnn4]01dec.24;2024Dec10.05:18;v2.2.500</anid> <title id="AN0181498508-1">Bariatric surgery and HIV: Joint venture between family, primary care, and HIV physicians </title> <p>ABSTRACT: We report a case of a 49-year-old female with a history of HIV infection for 12 years. The patient had excellent compliance with antiretroviral medications, raltegravir 400 mg twice daily and truvada once daily for HIV. Over the years, she maintained an undetectable viral load with a CD4+ count >200 cells/μL. She has a history of type II diabetes, hypertension, bipolar manic depression, endometriosis, recurrent herpes simplex attacks, arthritis in both shoulders, irritable bowel syndrome (IBS), and nonalcoholic fatty liver disease (NAFLD). She weighed 148 kg with a body mass index (BMI) of 52.08 kg/m<sup>2</sup>. Her medication included diltiazem 60 mg once a day, glyceryl trinitrate (GTN) spray, metformin 1 g twice daily, and linagliptin 500 mg once daily for her type II diabetes with glycated hemoglobin (HbA1c) of 8.4%. She has full capacity and elected to have bariatric surgery; 4 months postprocedure, she lost 28 kg with a reduced BMI of 38.62 kg/m<sup>2</sup> with no postoperative complications. Her diabetes control improved, and she no longer required linagliptin and metformin. Following the procedure, she was given supplements including ferrous sulfate, vitamin B12, vitamin D, and calcium. She was also prescribed lansoprazole. The case illustrates that bariatric surgery is an effective and safe operation for people living with HIV. Due to complex needs and the need for regular follow-up; primary care, family, and HIV physicians can all collaborate in the care of individuals living with HIV and who underwent bariatric surgery.</p> <p>Keywords: Bariatric surgery; diabetes; HIV; obesity</p> <hd id="AN0181498508-2">Introduction</hd> <p>Bariatric surgery (BS) is becoming increasingly performed in morbidly obese-positive HIV patients. One of the leading non-AIDS-defining causes of mortality among people living with HIV (PLWH) is cardiovascular disease (CVD). Over the past 2 decades, the global burden of CVD in HIV patients has tripled.[[<reflink idref="bib21" id="ref1">21</reflink>]] Risk factors for CVD such as obesity, diabetes mellitus, and dyslipidemia are associated with higher mortality in PLWH.[[<reflink idref="bib22" id="ref2">22</reflink>]] Given the detrimental effects of obesity on CVD risk, weight-management techniques are presently given increased importance in the routine care of PLWH.[[<reflink idref="bib23" id="ref3">23</reflink>]]</p> <p>Bariatric surgery restricts the volume of the food that can be ingested at one time while volume reduction of the digestive tract leads to malabsorption of consumed products. There are several types of bariatric surgeries, including Roux-en-Y Gastric Bypass surgery (RYGB), which causes food to bypass most of the stomach and the entire duodenum, hence food reaches the jejunum directly, which our patient has undergone.[[<reflink idref="bib24" id="ref4">24</reflink>]] Sleeve gastrectomy and gastric banding are alternative types of bariatric surgeries. Sleeve gastrectomy involves removing 80% of the stomach, leaving a small sleeve. RYGB reduces absorptive surface area by bypassing intestinal transporters in the duodenum, which affects oral bioavailability as some drugs require a more acidic environment for drugs to be absorbed, uncoated, and activated.[[<reflink idref="bib25" id="ref5">25</reflink>]] Thus, antiretrovirals (ARVs) like lamivudine, whose primary absorption sites are the duodenum and jejunum, have been demonstrated to have reduced absorption following bypass surgery. It was shown that there are lower serum levels of lamivudine following RYGB surgery compared with women living with HIV who had not undergone surgery.[[<reflink idref="bib27" id="ref6">27</reflink>]]</p> <p>In gastric banding, an obstructive band is placed around the proximal stomach to restrict the rate at which food can pass into the stomach. These procedures have restrictive features more than malabsorptive properties.[[<reflink idref="bib24" id="ref7">24</reflink>]] Nevertheless, restrictive features can still have an adverse impact on drug absorption due to decreased apparent drug clearance with increased drug exposure as drugs get absorbed in more distal sites of the intestine with reduced intestinal metabolism.[[<reflink idref="bib26" id="ref8">26</reflink>]] It is postulated that the absorption of ART specifically may be compromised in comparison with gastric sleeve.[[<reflink idref="bib27" id="ref9">27</reflink>]] However, there remains limited data on the use of ART post procedure in gastric bypass. Our case showed a unique outcome as a known case of an HIV-positive patient treated with Raltegravir 400 mg and Truvada 200 mg/300 mg who underwent gastric bypass surgery, which may decrease the surface of absorption of ART from the intestine. Two years post procedure, the patient lost weight, had good glycemic control, reported good ART compliance, and maintained viral suppression.</p> <hd id="AN0181498508-3">Case Report</hd> <p>We report a case of a 49-year-old female with a history of HIV infection diagnosed in 2011. The patient had excellent compliance with antiretroviral medications, raltegravir 400 mg twice daily and truvada once daily for HIV. Over the years, she maintained an undetectable viral load with a CD4+ count >200 cells/μL. She has a history of type II diabetes, hypertension, bipolar manic depression, endometriosis, recurrent herpes simplex attacks, arthritis in both shoulders, irritable bowel syndrome (IBS), and nonalcoholic fatty liver disease (NAFLD) diagnosed in 2022. She weighed 148 kg with a body mass index (BMI) of 52.08 kg/m<sups>2</sups>. Her medication included diltiazem 60 mg once a day, GTN spray, metformin 1 g twice daily, and linagliptin 500 mg once daily for her type II diabetes with glycated hemoglobin (HbA1c) of 8.4%. She has full capacity and elected to have bariatric surgery (RYGB); 4 months post procedure she lost 28 kgs with a reduced BMI of 38.62 kg/m<sups>2</sups> with no postoperative complications. Her diabetes control improved, and she no longer required linagliptin and metformin. Following the procedure, she was given supplements including ferrous sulfate, vitamin B12, vitamin D, and calcium. She was also prescribed lansoprazole.</p> <p>Despite bariatric surgery, her HIV infection status was not affected. With viral load remaining undetectable (HIV RNA < 1.30), she maintained a CD4 count of >200 cells/μL after the operation. Postoperatively, her viral load continued to be undetectable with a CD4 count of 770 cells/μL, 940 cells/μL, and 880 cells/μL at 6 months, 12 months, and 24 months, respectively [Table 1 and Figure 1]. A DEXA scan was performed in November 2022, which revealed a normal bone density score, with a lumbar spine T-score of 2.2, and a femoral neck T-score of –0.7. The FRAX score revealed a 10-year risk of osteoporotic fracture score of 3.2, and the risk of hip fracture in 10 years is 0.1%. The patient gave consent for the publication of the case report. Milton Keynes University Hospital always endorses and approves scientific publications of this kind of manuscript.</p> <p>Graph: Table 1 Baseline changes following surgery, 1 year, and 2 years postsurgery</p> <p>Graph: Figure 1 Illustrating a line graph of change in clinical parameters preprocedure, postprocedure ½ years, postprocedure 1 year, and postprocedure 2 years. (a) HbA1c, (b) weight (kg), (c) BMI (kg/m2), and (d) CD4 cell count and viral load</p> <hd id="AN0181498508-4">Discussion</hd> <p>We present a case of an HIV-positive female patient who underwent bariatric surgery and achieved significant weight loss and improvement in glycemic control. She maintained an undetectable viral load count with excellent compliance with ARVs.</p> <p>In this case, this patient was taking raltegravir and truvada, which is a combination treatment of tenofovir disoproxil fumarate (DF) and emtricitabine. Raltegravir is normally absorbed in the ileum, thus, bypass surgery would not impact its reabsorption as demonstrated by this patient.[[<reflink idref="bib29" id="ref10">29</reflink>]] Furthermore, raltegravir is considered to have increased exposure in higher gastric pH,[[<reflink idref="bib30" id="ref11">30</reflink>]] therefore, its pharmacokinetics are not negatively impacted by PPIs given postbariatric surgery.</p> <p>Tenofovir DF and emtricitabine are presumed to be reabsorbed in the small intestine, as detailed evidence of their pharmacokinetics is not currently available. Studies have shown that the exposure of tenofovir and emtricitabine DF undergoes a transient decrease with the maintenance of virological suppression.[[<reflink idref="bib31" id="ref12">31</reflink>]]</p> <p>Bariatric surgery may have a significant impact on antiretrovirals that require an acidic environment, fatty meal administration, prolonged dissolution times, and enterohepatic recirculation for absorption.[[<reflink idref="bib23" id="ref13">23</reflink>]] Absorption of certain antiretrovirals could be impacted negatively by interacting with common medications prescribed postbariatric surgery, such as proton pump inhibitors, which are given to prevent gastric complications. However, this may reduce the absorption of ARVs that depend on low-pH solubility, for instance, atazanavir and rilpivirine.</p> <p>Given the physiological changes following bariatric surgery, many studies explored the efficacy of ART in patients with morbid obesity living with HIV. The most recent study published[[<reflink idref="bib33" id="ref14">33</reflink>]] showed that 94% of patients who underwent RYGB and SG maintained an undetectable viral load with no significant changes in baseline CD4+ cell count 12 months after the surgery. One patient who underwent gastric sleeve developed virological failure following vitamin deficiency for 6 months post surgery. Other studies in support of bariatric surgery as a safe treatment modality in patients with HIV.[[<reflink idref="bib34" id="ref15">34</reflink>]]</p> <p>The general concern of HIV management after bariatric surgery is due to the reduced efficacy of ARVs secondary to decreased exposure and compliance with ARTs. In this case report, our patient living with HIV and having undergone gastric bypass surgery did not show any evidence of virological failure within 2 years post procedure; viral load remained undetectable and CD4+ T count >200 cells/mm<sups>3</sups> as shown in Figure 1d. The postprocedure parameters showed evidence of resolved type II diabetes with a significant reduction in HbA1c and BMI, thus no longer requiring antidiabetic medications. The weight status of this patient's 1-year postprocedure shows a weight decrease from 137 kg to 105 kg over a period of a year as shown in Figure 1. This may be due to multiple factors, including exacerbating psychiatric symptoms given the patient's history of bipolar manic depression.</p> <p>Importantly, several studies showed the beneficial benefit of RYGP surgery. For instance, Kaip <emph>et al</emph>.[[<reflink idref="bib33" id="ref16">33</reflink>]] showed that in 18 patients (7 patients underwent RYGB and 11 underwent SG), 17 of 18 patients (94%) maintained virological suppression within 12 months postsurgery and satisfactory CD4+ count apart from one patient who underwent sleeve gastrectomy surgery. Piso <emph>et al</emph>.[[<reflink idref="bib35" id="ref17">35</reflink>]] showed that dolutegravir plasma levels did not change after gastric bypass surgery with durable viral suppression. Amouyal <emph>et al</emph>.[[<reflink idref="bib36" id="ref18">36</reflink>]] showed that sleeve gastrectomy was associated with significant weight reduction but variable responses in terms of viral load in 6 months follow-up after the operation (12 patients had undetectable viral load, 4 displayed detectable viral loads along with a significant decrease in raltegravir and atazanavir treatment exposure, leading to ART change with subsequent undetectable viral load; and 1 had persistent detectable viral load despite ART change). Sleeve gastrectomy was also shown to lead to remission of diabetes, excellent glycemic, weight reduction, and suppression of viral load.[[<reflink idref="bib34" id="ref19">34</reflink>], [<reflink idref="bib37" id="ref20">37</reflink>]]</p> <p>It has been increasingly acknowledged that procedures such as SG and RYGB can adversely affect skeletal health, with an increased risk of developing malabsorption and osteoporosis.[[<reflink idref="bib38" id="ref21">38</reflink>]] However, a DEXA scan performed 24 months after the procedure revealed that she is at low risk for osteoporosis with a normal bone density score. Her 10-year risk of osteoporotic fracture score was 3.2, and her 10-year risk of hip fracture was 0.1%, indicating a low risk for osteoporosis.[[<reflink idref="bib39" id="ref22">39</reflink>]] Osteoporosis is highly prevalent among individuals living with HIV.[[<reflink idref="bib40" id="ref23">40</reflink>]]</p> <p>Limitations of this study: this is a single-patient focus study and there is a need for further studies to generalize the findings. Long-term follow-up studies for 10 years are needed to look at the long-term impact of bariatric surgery on HIV medication, mortality, morbidity, and impact on the micro and macro nutritional substances. It is worth mentioning that the safety and efficacy of bariatric surgery among individuals living with HIV need to be studied in large-scale or randomized clinical trials.</p> <hd id="AN0181498508-5">Conclusion</hd> <p>In conclusion, this case report illustrates the effectiveness of bariatric surgery in patients with HIV. This patient has maintained excellent HIV control and achieved good metabolic outcomes. Due to complex needs and the need for regular follow-up and the unpredictability of variation of response of viral loads; primary care, family, and HIV physicians can all collaborate in the care of individuals living with HIV and undergoing bariatric surgery.</p> <hd id="AN0181498508-6">Presentation</hd> <p>The case report is presented as an oral presentation in the clinical update meeting (April 2022-Birmingham, UK) of the Society of Endocrinology and a copy of the abstract can be accessed from https://<ulink href="http://www.endocrine-abstracts.org/ea/0082/ea0082wg2">www.endocrine-abstracts.org/ea/0082/ea0082wg2</ulink>.</p> <hd id="AN0181498508-7">Declaration of patient consent</hd> <p>The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.</p> <hd id="AN0181498508-8">Financial support and sponsorship</hd> <p>Nil.</p> <hd id="AN0181498508-9">Conflicts of interest</hd> <p>There are no conflicts of interest.</p> <ref id="AN0181498508-10"> <title> REFERENCES </title> <blist> <bibl id="bib1" type="bt">1</bibl> <bibtext> Shah ASV, Stelzle D, Lee KK, Beck EJ, Alam S, Chifford S, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV. Circulation. 2018; 138: 1100–12.</bibtext> </blist> <blist> <bibl id="bib2" type="bt">2</bibl> <bibtext> Chang H. Cardiovascular diseases in HIV patients. Cardiovasc Prev Pharmacother. 2022; 4: 95–8.</bibtext> </blist> <blist> <bibl id="bib3" type="bt">3</bibl> <bibtext> Zino L, Kingma JS, Marzolini C, Richel O, Burger DM, Colbers A. Implications of bariatric surgery on the pharmacokinetics of antiretrovirals in people living with HIV. Clin Pharmacokinet. 2022; 61: 619–35.</bibtext> </blist> <blist> <bibl id="bib4" type="bt">4</bibl> <bibtext> Lorico S, Colton B. Medication management and pharmacokinetic changes after bariatric surgery. Can Fam Physician. 2020; 66: 409–16.</bibtext> </blist> <blist> <bibl id="bib5" type="bt">5</bibl> <bibtext> Smith A, Henriksen B, Cohen A. Pharmacokinetic considerations in Roux-en-Y gastric bypass patients. Am J Health Syst Pharm. 2011; 68: 2241–7.</bibtext> </blist> <blist> <bibl id="bib6" type="bt">6</bibl> <bibtext> Chan G, Hajjar R, Boutin L, Garneau P, Pichette V, Lafrance J, et al. Prospective study of the changes in pharmacokinetics of immunosuppressive medications after laparoscopic sleeve gastrectomy. Am J Transplant. 2019; 20: 582–8.</bibtext> </blist> <blist> <bibl id="bib7" type="bt">7</bibl> <bibtext> Cimino C, Binkley A, Swisher R, Short WR. Antiretroviral considerations in HIV-infected patients undergoing bariatric surgery. J Clin Pharm Ther. 2018; 43: 757–67.</bibtext> </blist> <blist> <bibl id="bib8" type="bt">8</bibl> <bibtext> Michalik DE, Jackson-Alvarez JT, Flores R, Tolentino-Baldridge C, Batra JS. Low third-trimester serum levels of lamivudine/zidovudine and lopinavir/ritonavir in an HIV-infected pregnant woman with gastric bypass. J Int Assoc Provid AIDS Care. 2015; 14: 116–9.</bibtext> </blist> <blist> <bibl id="bib9" type="bt">9</bibl> <bibtext> Moss DM, Siccardi M, Back DJ, Owen A. Predicting intestinal absorption of raltegravir using a population-based ADME simulation. J Antimicrob Chemother. 2013; 68: 1627–34.</bibtext> </blist> <blist> <bibtext> Moss DM, Siccardi M, Murphy M, Piperakis MM, Khoo SH, Back DJ, et al. Divalent metals and pH alter raltegravir disposition in vitro. Antimicrob Agents Chemother. 2012; 56: 3020–6.</bibtext> </blist> <blist> <bibtext> Baettig V, Courlet P, Delko T, Battegay M, Marzolini C. Boosted darunavir, emtricitabine and tenofovir pharmacokinetics in the early and late postgastric bypass surgery periods. AIDS. 2018; 32: 1903–5.</bibtext> </blist> <blist> <bibtext> MacBrayne CE, Blum JD, Kiser JJ. Tenofovir, emtricitabine, and darunavir/ritonavir pharmacokinetics in an HIV-infected patient after Roux-en-Y gastric bypass surgery. Annals Pharmacother. 2014; 48: 816–9.</bibtext> </blist> <blist> <bibtext> Kaip EA, Nguyen NY, Cocohoba JM. Antiretroviral therapy efficacy post-bariatric weight loss surgery:A case series of persons living with human immunodeficiency virus. Obes Surg. 2022; 32: 1523–30.</bibtext> </blist> <blist> <bibtext> Yang W, Zalin A, Nelson M, Bonanomi G, Smellie J, Shotliff K, et al. Bariatric surgery in individuals with human immunodeficiency virus and type 2 diabetes:A case series. J Med Case Rep. 2019; 13: 146.</bibtext> </blist> <blist> <bibtext> Piso RJ, Battegay M, Marzolini C. Dolutegravir plasma levels after gastric bypass surgery. AIDS. 2017; 31: 1052–4.</bibtext> </blist> <blist> <bibtext> Amouyal C, Buyse M, Lucas-Martini L, Hirt D, Genser L, Torcivia A, et al. Sleeve gastrectomy in morbidly obese HIV patients:Focus on anti-retroviral treatment absorption after surgery. Obes Surg. 2018; 28: 2886–93.</bibtext> </blist> <blist> <bibtext> de Souza TF, Madruga Neto AC, Coronel MA, Grecco E, Quadros LG, Silva M, et al. The first study evaluating effectiveness and safety of the endoscopic sleeve gastroplasty in HIV patients. Obes Surg. 2020; 30: 1159–62.</bibtext> </blist> <blist> <bibtext> Paccou J, Caiazzo R, Lespessailles E, Cortet B. Bariatric surgery and osteoporosis. Calcif Tissue Int. 2021; 110: 576–91.</bibtext> </blist> <blist> <bibtext> Buchacz K, Baker R, Palella F Jr, Shaw L, Patel P, Lichtenstein K, et al. Disparities in prevalence of key chronic diseases by gender and race/ethnicity among antiretroviral-treated HIV-infected adults in the US. Antivir Ther. 2012; 18: 65–75.</bibtext> </blist> <blist> <bibtext> Ahmed M, Mital D, Abubaker NE, Panourgia M, Owles H, Papadaki I, et al. Bone health in people living with HIV/AIDS:An update of where we are and potential future strategies. Microorganisms. 2023; 11: 789.</bibtext> </blist> <blist> <bibtext> Shah ASV, Stelzle D, Lee KK, Beck EJ, Alam S, Chifford S, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV. Circulation. 2018; 138: 1100–12.</bibtext> </blist> <blist> <bibtext> Chang H. Cardiovascular diseases in HIV patients. Cardiovasc Prev Pharmacother. 2022; 4: 95–8.</bibtext> </blist> <blist> <bibtext> Zino L, Kingma JS, Marzolini C, Richel O, Burger DM, Colbers A. Implications of bariatric surgery on the pharmacokinetics of antiretrovirals in people living with HIV. Clin Pharmacokinet. 2022; 61: 619–35.</bibtext> </blist> <blist> <bibtext> Lorico S, Colton B. Medication management and pharmacokinetic changes after bariatric surgery. Can Fam Physician. 2020; 66: 409–16.</bibtext> </blist> <blist> <bibtext> Smith A, Henriksen B, Cohen A. Pharmacokinetic considerations in Roux-en-Y gastric bypass patients. Am J Health Syst Pharm. 2011; 68: 2241–7.</bibtext> </blist> <blist> <bibtext> Chan G, Hajjar R, Boutin L, Garneau P, Pichette V, Lafrance J, et al. Prospective study of the changes in pharmacokinetics of immunosuppressive medications after laparoscopic sleeve gastrectomy. Am J Transplant. 2019; 20: 582–8.</bibtext> </blist> <blist> <bibtext> Cimino C, Binkley A, Swisher R, Short WR. Antiretroviral considerations in HIV-infected patients undergoing bariatric surgery. J Clin Pharm Ther. 2018; 43: 757–67.</bibtext> </blist> <blist> <bibtext> Michalik DE, Jackson-Alvarez JT, Flores R, Tolentino-Baldridge C, Batra JS. Low third-trimester serum levels of lamivudine/zidovudine and lopinavir/ritonavir in an HIV-infected pregnant woman with gastric bypass. J Int Assoc Provid AIDS Care. 2015; 14: 116–9.</bibtext> </blist> <blist> <bibtext> Moss DM, Siccardi M, Back DJ, Owen A. Predicting intestinal absorption of raltegravir using a population-based ADME simulation. J Antimicrob Chemother. 2013; 68: 1627–34.</bibtext> </blist> <blist> <bibtext> Moss DM, Siccardi M, Murphy M, Piperakis MM, Khoo SH, Back DJ, et al. Divalent metals and pH alter raltegravir disposition in vitro. Antimicrob Agents Chemother. 2012; 56: 3020–6.</bibtext> </blist> <blist> <bibtext> Baettig V, Courlet P, Delko T, Battegay M, Marzolini C. Boosted darunavir, emtricitabine and tenofovir pharmacokinetics in the early and late postgastric bypass surgery periods. AIDS. 2018; 32: 1903–5.</bibtext> </blist> <blist> <bibtext> MacBrayne CE, Blum JD, Kiser JJ. Tenofovir, emtricitabine, and darunavir/ritonavir pharmacokinetics in an HIV-infected patient after Roux-en-Y gastric bypass surgery. Annals Pharmacother. 2014; 48: 816–9.</bibtext> </blist> <blist> <bibtext> Kaip EA, Nguyen NY, Cocohoba JM. Antiretroviral therapy efficacy post-bariatric weight loss surgery:A case series of persons living with human immunodeficiency virus. Obes Surg. 2022; 32: 1523–30.</bibtext> </blist> <blist> <bibtext> Yang W, Zalin A, Nelson M, Bonanomi G, Smellie J, Shotliff K, et al. Bariatric surgery in individuals with human immunodeficiency virus and type 2 diabetes:A case series. J Med Case Rep. 2019; 13: 146.</bibtext> </blist> <blist> <bibtext> Piso RJ, Battegay M, Marzolini C. Dolutegravir plasma levels after gastric bypass surgery. AIDS. 2017; 31: 1052–4.</bibtext> </blist> <blist> <bibtext> Amouyal C, Buyse M, Lucas-Martini L, Hirt D, Genser L, Torcivia A, et al. Sleeve gastrectomy in morbidly obese HIV patients:Focus on anti-retroviral treatment absorption after surgery. Obes Surg. 2018; 28: 2886–93.</bibtext> </blist> <blist> <bibtext> de Souza TF, Madruga Neto AC, Coronel MA, Grecco E, Quadros LG, Silva M, et al. The first study evaluating effectiveness and safety of the endoscopic sleeve gastroplasty in HIV patients. Obes Surg. 2020; 30: 1159–62.</bibtext> </blist> <blist> <bibtext> Paccou J, Caiazzo R, Lespessailles E, Cortet B. Bariatric surgery and osteoporosis. Calcif Tissue Int. 2021; 110: 576–91.</bibtext> </blist> <blist> <bibtext> Buchacz K, Baker R, Palella F Jr, Shaw L, Patel P, Lichtenstein K, et al. Disparities in prevalence of key chronic diseases by gender and race/ethnicity among antiretroviral-treated HIV-infected adults in the US. Antivir Ther. 2012; 18: 65–75.</bibtext> </blist> <blist> <bibtext> Ahmed M, Mital D, Abubaker NE, Panourgia M, Owles H, Papadaki I, et al. Bone health in people living with HIV/AIDS:An update of where we are and potential future strategies. Microorganisms. 2023; 11: 789.</bibtext> </blist> </ref> <aug> <p>By Ceren Aydemir; Raniah Al Saidi; Ji Soo Choi; Mohamed H. Ahmed and Dushyant Mital</p> <p>Reported by Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib21" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib22" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib23" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib24" firstref="ref4"></nolink> <nolink nlid="nl5" bibid="bib25" firstref="ref5"></nolink> <nolink nlid="nl6" bibid="bib27" firstref="ref6"></nolink> <nolink nlid="nl7" bibid="bib26" firstref="ref8"></nolink> <nolink nlid="nl8" bibid="bib29" firstref="ref10"></nolink> <nolink nlid="nl9" bibid="bib30" firstref="ref11"></nolink> <nolink nlid="nl10" bibid="bib31" firstref="ref12"></nolink> <nolink nlid="nl11" bibid="bib33" firstref="ref14"></nolink> <nolink nlid="nl12" bibid="bib34" firstref="ref15"></nolink> <nolink nlid="nl13" bibid="bib35" firstref="ref17"></nolink> <nolink nlid="nl14" bibid="bib36" firstref="ref18"></nolink> <nolink nlid="nl15" bibid="bib37" firstref="ref20"></nolink> <nolink nlid="nl16" bibid="bib38" firstref="ref21"></nolink> <nolink nlid="nl17" bibid="bib39" firstref="ref22"></nolink> <nolink nlid="nl18" bibid="bib40" firstref="ref23"></nolink>
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  Data: Bariatric surgery and HIV: Joint venture between family, primary care, and HIV physicians
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Ceren+Aydemir%22">Ceren Aydemir</searchLink><br /><searchLink fieldCode="AR" term="%22Raniah+Al+Saidi%22">Raniah Al Saidi</searchLink><br /><searchLink fieldCode="AR" term="%22Ji+Soo+Choi%22">Ji Soo Choi</searchLink><br /><searchLink fieldCode="AR" term="%22Mohamed+H%2E+Ahmed%22">Mohamed H. Ahmed</searchLink><br /><searchLink fieldCode="AR" term="%22Dushyant+Mital%22">Dushyant Mital</searchLink>
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  Label: Source
  Group: Src
  Data: Journal of Family Medicine and Primary Care, Vol 13, Iss 12, Pp 5920-5923 (2024)
– Name: Publisher
  Label: Publisher Information
  Group: PubInfo
  Data: Wolters Kluwer Medknow Publications, 2024.
– Name: DatePubCY
  Label: Publication Year
  Group: Date
  Data: 2024
– Name: Subset
  Label: Collection
  Group: HoldingsInfo
  Data: LCC:Medicine
– Name: Subject
  Label: Subject Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22bariatric+surgery%22">bariatric surgery</searchLink><br /><searchLink fieldCode="DE" term="%22diabetes%22">diabetes</searchLink><br /><searchLink fieldCode="DE" term="%22hiv%22">hiv</searchLink><br /><searchLink fieldCode="DE" term="%22obesity%22">obesity</searchLink><br /><searchLink fieldCode="DE" term="%22Medicine%22">Medicine</searchLink>
– Name: Abstract
  Label: Description
  Group: Ab
  Data: We report a case of a 49-year-old female with a history of HIV infection for 12 years. The patient had excellent compliance with antiretroviral medications, raltegravir 400 mg twice daily and truvada once daily for HIV. Over the years, she maintained an undetectable viral load with a CD4+ count >200 cells/μL. She has a history of type II diabetes, hypertension, bipolar manic depression, endometriosis, recurrent herpes simplex attacks, arthritis in both shoulders, irritable bowel syndrome (IBS), and nonalcoholic fatty liver disease (NAFLD). She weighed 148 kg with a body mass index (BMI) of 52.08 kg/m2. Her medication included diltiazem 60 mg once a day, glyceryl trinitrate (GTN) spray, metformin 1 g twice daily, and linagliptin 500 mg once daily for her type II diabetes with glycated hemoglobin (HbA1c) of 8.4%. She has full capacity and elected to have bariatric surgery; 4 months postprocedure, she lost 28 kg with a reduced BMI of 38.62 kg/m2 with no postoperative complications. Her diabetes control improved, and she no longer required linagliptin and metformin. Following the procedure, she was given supplements including ferrous sulfate, vitamin B12, vitamin D, and calcium. She was also prescribed lansoprazole. The case illustrates that bariatric surgery is an effective and safe operation for people living with HIV. Due to complex needs and the need for regular follow-up; primary care, family, and HIV physicians can all collaborate in the care of individuals living with HIV and who underwent bariatric surgery.
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  Data: English
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  Data: 2249-4863<br />2278-7135
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  Data: https://journals.lww.com/10.4103/jfmpc.jfmpc_730_24; https://doaj.org/toc/2249-4863; https://doaj.org/toc/2278-7135
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  Data: 10.4103/jfmpc.jfmpc_730_24
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.4103/jfmpc.jfmpc_730_24
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 4
        StartPage: 5920
    Subjects:
      – SubjectFull: bariatric surgery
        Type: general
      – SubjectFull: diabetes
        Type: general
      – SubjectFull: hiv
        Type: general
      – SubjectFull: obesity
        Type: general
      – SubjectFull: Medicine
        Type: general
    Titles:
      – TitleFull: Bariatric surgery and HIV: Joint venture between family, primary care, and HIV physicians
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Ceren Aydemir
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            NameFull: Raniah Al Saidi
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            NameFull: Ji Soo Choi
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            NameFull: Mohamed H. Ahmed
      – PersonEntity:
          Name:
            NameFull: Dushyant Mital
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          Dates:
            – D: 01
              M: 12
              Type: published
              Y: 2024
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              Value: 13
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              Value: 12
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            – TitleFull: Journal of Family Medicine and Primary Care
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