Endocrine Abstracts

Introduction: Bariatric surgery was shown to treat obesity and decrease cardiovascular risk such as metabolic syndrome, diabetes, and hypertension. In individuals living with HIV, bariatric surgery can alter oral bioavailability of anti-viral therapy through its impact on the intestinal pH, intestinal transit time and first pass mechanism. This can have adverse impact on CD4 count and viral load (VL). Nevertheless, numerous studies highlight that bariatric surgery does not have any short-term complications on individuals receiving ART and one study showed that showed that 70% of patients had undetectable VL with correct ART kinetic parameters six months after the operation.

Case report: A case of 49-year-old African female with HIV with excellent compliance to antiretrovirals. She is known to have Type 2 diabetes mellitus controlled with tablets, liver cirrhosis, hypertension, and endometriosis. Unfortunately, over the years, she developed gross obesity with body mass index (BMI) of 52.08 kg/m2 and weight of 148 kg. Prior to bariatric surgery, she had poor glycaemic control with HbA1c of 8.4%. Her HIV was controlled well with Raltegavir and Trurada and her CD4 count was >200 with undetectable VL. She underwent sleeve gastrectomy and did not experience any post-operative complication. 4 months post-operation, she lost 28 kg, lowering her BMI to 38.62 kg/m2. Her diabetes control improved with HbA1c of 5.5% with glycated haemoglobin of 37% and no longer required diabetic medications. Despite bariatric surgery, her VL remained undetectable with HIV RNA below 1.30 and maintained CD4 count above 200.

Conclusion: Despite the risk associated with bariatric surgery, our case report clearly showed that bariatric surgery can be safe and effective in individuals living with HIV. Further research is needed to establish (i) whether there is ethnic variation in relation to the outcome (ii) if certain antiretroviral medication is well absorbed with bariatric surgery (iii) and whether genetic variation may have role. Nevertheless, such patients will require close monitoring to ensure adequate viral control.