Sleeve Gastrectomy in Morbidly Obese HIV Patients: Focus on Anti-retroviral Treatment Absorption After Surgery

Amouyal, Chloé; Buyse, Marion; Lucas-Martini, L; Hirt, Déborah; Genser, Laurent; Torcivia, Adriana; Bouillot, Jean‐Luc; Oppert, Jean‐Michel; Aron‐Wisnewsky, Judith

doi:10.1007/s11695-018-3308-7

Cited by 23 publications

(29 citation statements)

References 45 publications

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“…The influence of SG on the pharmacokinetics of nine different antiretroviral drugs was investigated in HIV patients 3 and 6 months following surgery . There were some potential large pharmacokinetic effects shown in this study.…”

Section: Resultsmentioning

confidence: 97%

“…RYGBP was the predominant surgical procedure (n = 18) . In one study, BPD was investigated as the surgical procedure, while two studies investigated BPD‐DS, six studied SG, and one included jejunoileostomy …”

Section: Resultsmentioning

confidence: 99%

“…Among the 22 studies, 16 utilized a single‐dose design, administering a given dose of the studied drug on the day of the pharmacokinetic study intervention. In the remaining six studies, patients were investigated in steady state . Several drugs were studied because of their status as probe drugs/substrates for different CYP enzymes and drug transporters, eg, midazolam for CYP3A as well as digoxin for P‐gp .…”

Section: Resultsmentioning

confidence: 99%

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The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

et al. 2019

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Summary Anatomical changes in the gastrointestinal tract and subsequent weight loss may influence drug disposition and thus drug dosing following bariatric surgery. This review systematically examines the effects of bariatric surgery on drug pharmacokinetics, focusing especially on the mechanisms involved in restricting oral bioavailability. Studies with a longitudinal before‐after design investigating the pharmacokinetics of at least one drug were reviewed. The need for dose adjustment following bariatric surgery was examined, as well as the potential for extrapolation to other drugs subjected to coinciding pharmacokinetic mechanisms. A total of 22 original articles and 32 different drugs were assessed. The majority of available data is based on Roux‐en‐Y gastric bypass (RYGBP) (18 of 22 studies), and hence, the overall interpretation is more or less limited to RYGBP. In the case of the majority of studied drugs, an increased absorption rate was observed early after RYGBP. The effect on systemic exposure allows for a low degree of extrapolation, including between drugs subjected to the same major metabolic and transporter pathways. On the basis of current understanding, predicting the pharmacokinetic change for a specific drug following RYGBP is challenging. Close monitoring of each individual drug is therefore recommended in the early postsurgical phase. Future studies should focus on the long‐term effects of bariatric surgery on drug disposition, and they should also aim to disentangle the effects of the surgery itself and the subsequent weight loss.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

et al. 2019

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“…Of the total 21 studies, some conducted more than one procedure: 19 studies investigated RYGB, five investigated SG, two investigated BPD‐DS, and one study investigated mini‐GB . The number of participants in these studies ranged from five patients in a single study to a maximum of 34 patients.…”

Section: Resultsmentioning

confidence: 99%

“…The drugs investigated in this review were benzodiazepines: midazolam; anti‐arrhythmics: digoxin; corticosteroids: hydrocortisone; hormonal: desogestrel; antidepressants: venlafaxine, escitalopram, duloxetine, citalopram, and sertraline; antihypertensives: metoprolol; lipid‐reducing drugs: fenofibrate, and atorvastatin; anti‐infectives: posaconazole, amoxicillin, and linezolid; analgesics: morphine, and paracetamol; anticoagulant: rivaroxaban; and antiplatelet: aspirin; and acid‐reducing drugs: omeprazole . Amouyal et al included drugs for treatment of human immunodeficiency virus (HIV), namely, the combinations of the antiretroviral drugs: abacavir, atazanavir, efavirenz, emtricitabine, lamivudine, darunavir, raltegravir, ritonavir, and tenofovir …”

Section: Resultsmentioning

confidence: 99%

Pharmacokinetic changes post–bariatric surgery: A scoping review

McLachlan

Chaar

2020

Obesity Reviews

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Summary Bariatric surgeries induce structural changes that can alter the absorption of drugs in patients already at risk of polypharmacy. This scoping review aimed to explore pharmacokinetic changes of orally administered drugs in patients post‐bariatric surgery, and assess the quality and level of bias. Electronic databases were searched for articles relating to bariatric surgery and pharmacokinetics published between 1998 and 2019. Pre‐post studies reporting on pharmacokinetic parameters were included, and the Newcastle‐Ottawa Scale was used to assess risk‐of‐bias. A total of 21 studies were included in this review, and changes in absorption were reported in all included studies across 29 drugs. In 11 studies, this change was reported as statistically significant (p<.05), while six reported a nonsignificant change. More drugs exhibited a shorter Tmax and higher Cmax after surgery than otherwise, however changes in AUC were variable. Four studies were assessed as having fair quality while the remainder of the included studies were of good quality and low risk‐of‐bias. Bariatric surgery alters the absorption of drugs and several mechanisms are implicated to be responsible. Short and long‐term monitoring is recommended in patients post‐surgery for clinical changes in response to medications. Future research with a higher number of participants and greater control of variables, such as concurrent medications, malabsorptive disorders, and body composition should be considered.

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Antiretroviral Therapy Efficacy Post-Bariatric Weight Loss Surgery: A Case Series of Persons Living with Human Immunodeficiency Virus

2022

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Purpose Human immunodeficiency virus (HIV)–related mortality has decreased secondary to advances in antiretroviral therapy (ART), and the incidence of obesity in this population is increasing. Bariatric surgery is an effective method of weight loss, though changes in the gastrointestinal tract may affect ART absorption and virologic suppression. Existing data are limited to case reports studying outdated therapeutic regimens; studies evaluating modern ART regimens are needed. The objective of this study was to determine if undergoing bariatric surgery impacts HIV virologic failure rate at 12 months post-surgery and to characterize the failure population. Materials and Methods This retrospective case series included adults with virologically suppressed HIV on ART who underwent roux-en-y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery between 2000 and 2019 (n=20) at one of three medical centers within one academic medical system. The primary outcome was proportion of patients with ART failure at 12 months post-surgery. Select additional data collected included CD4+ count, metabolic parameters, postoperative complications, and medication non-adherence. Results A total of 18 patients were included in this analysis. Seventeen of 18 patients (94%) maintained virologic suppression within 12 months post-surgery. There were no significant changes in CD4+ counts before and after surgery. The one failure was an African American woman who underwent sleeve gastrectomy surgery. This patient’s baseline viral load was undetectable and CD4+ count was 263 cells/mm3. Conclusion Undergoing bariatric surgery did not increase virologic failure rate in a small cohort of persons living with HIV, and ART non-adherence was associated with virologic failure. Graphical abstract

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Sleeve Gastrectomy in Morbidly Obese HIV Patients: Focus on Anti-retroviral Treatment Absorption After Surgery

Abstract: SG seems effective and safe in obese HIV patients. However, ART treatment should be monitored post-SG to control HIV infection. We suggest that some ART should be adapted before SG conjoints with infectious disease specialists.

Cited by 23 publications

References 45 publications

The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

The influence of bariatric surgery on oral drug bioavailability in patients with obesity: A systematic review

Pharmacokinetic changes post–bariatric surgery: A scoping review

Antiretroviral Therapy Efficacy Post-Bariatric Weight Loss Surgery: A Case Series of Persons Living with Human Immunodeficiency Virus

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