Evolution of severe obesity and associated comorbidities in persons living with HIV with and without bariatric surgery at short and long term follow up

Objectives: Obesity and related comorbidities are increasing among people living with HIV (PLWH). This study compared the evolution of severe obesity and related comorbidities in PLWH with (cases) or without (controls) bariatric surgery (BS).

Methods: Monocentric retrospective comparison of PLWH with severe obesity (body mass index (BMI) ≥40 kg/m² or BMI ≥ 35 together with ≥ 1 comorbidity (diabetes, dyslipidemia, arterial hypertension, sleep apnea, cardiovascular events)) between cases at baseline, 1, 2, 5 and 10 years after BS or as controls matched (1:3) on age, gender, ethnicity and severe obesity criteria.

Results: Between 2006 and 2019, we included 27 cases and 73 controls: 84% female, median age 43 years, 78% originated from sub-Saharan Africa; median time with HIVRNA <50 cp/ml 6 years in both groups. BMI decreased from 41 (baseline) to 29 kg/m² at 2 years after BS (p=0.002) while controls remained at 37 kg/m² both at baseline and 2 years. At 5 and 10 years, BMI was ≤31 in cases while controls remained ≥ 35 kg/m². Comorbidities favorable evolution at 2 years occurred in 50% of cases versus 12.5% in controls for diabetes, 44% versus 0 (p=0.006) for hypertension and 90% versus 0 (p<0.0001) for sleep apnea. Post-operative complications rate was 11% and HIV infection remained under control after BS.

Conclusion: Bariatric surgery is a safe and efficient treatment of severe obesity and its related comorbidities among patients with well-controlled HIV at short, middle and long terms with no impact on control of HIV disease.