Department of Pharmacy and Radboudumc Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands.
Data Analysis, Reporting & Research Unit, Stichting HIV Monitoring, Amsterdam, The Netherlands.
Clin Infect Dis. 2023 Nov 30;77(11):1561-1568. doi: 10.1093/cid/ciad404.
The implications of bariatric surgery (BS) on virologic and metabolic outcomes in people with human immunodeficiency virus (HIV; PWH) on antiretroviral therapy (ART) are unknown.
Here, we report a retrospective analysis up to 18 months post-BS in PWH from the AIDS Therapy evaluation in The Netherlands (ATHENA) cohort with data from all dutch HIV treating Centers. Primary end points were a confirmed virologic failure (2 consecutive HIV-RNA measurements >200 copies/mL) and the percentage of patients who achieved >20% total body weight loss up to 18 months post-BS. Switches from baseline ART and trough plasma concentrations of antiretrovirals were also reported post-BS. Metabolic parameters and medication usage were compared pre- and post-BS.
Fifty-one patients were included. One case of confirmed virologic failure and 3 cases with viral blips were detected in this cohort up to 18 months post-BS. Eighty-five percent of patients achieved >20% total body weight loss at 18 months post-BS, with a mean difference from baseline (95% confidence interval) of -33.5% (-37.7% to -29.3%). Trough plasma concentrations of measured antiretroviral agents were all above minimum effective concentrations, except for 1 sample of darunavir. Lipid profiles, but not serum creatinine and blood pressure, improved significantly (P < .01) post-BS. Total medications and obesity-related comedications declined from 203 to 103 and from 62 to 25, respectively, at 18 months post-BS.
BS was an effective intervention for weight loss and lipid control in PWH using ART in this cohort with no clear link to poor virologic outcomes.
接受抗病毒治疗（ART）的人类免疫缺陷病毒（HIV）感染者（PWH）行减重手术（BS）对病毒学和代谢结果的影响尚不清楚。
我们对 AIDS Therapy evaluation in The Netherlands（ATHENA）队列中接受过 BS 的 PWH 进行了一项回顾性分析，分析截至 BS 后 18 个月，该队列数据来自所有荷兰 HIV 治疗中心。主要终点是确诊的病毒学失败（2 次连续 HIV-RNA 测量值＞200 拷贝/ml）和达到 BS 后 18 个月时体重减轻＞20%的患者比例。还报告了 BS 后的 ART 转换和抗逆转录病毒药物的谷血浆浓度。比较了 BS 前后的代谢参数和药物使用情况。
该队列共纳入 51 例患者。BS 后 18 个月内，该队列中有 1 例确诊的病毒学失败病例和 3 例病毒学反弹病例。85%的患者在 BS 后 18 个月时体重减轻＞20%，与基线相比平均差值为-33.5%（95%置信区间：-37.7%至-29.3%）。除 1 例达芦那韦样本外，所测量的抗逆转录病毒药物的谷血浆浓度均高于最小有效浓度。BS 后，血脂谱明显改善（P＜0.01），但血清肌酐和血压无明显变化。BS 后 18 个月时，总用药和肥胖相关药物的数量分别从 203 种和 62 种降至 103 种和 25 种。
在本队列中，BS 是接受 ART 的 PWH 体重减轻和血脂控制的有效干预措施，与病毒学结果不佳无明显关联。
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