Surgery for obesity & metabolic diseases
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The specific answer to this question is: Yes, yes you are a candidate for weight loss surgery while still suffering from HIV or some other autoimmune disease. In this article, we will focus mainly on the issue of HIV.
As everyone knows, HIV is a disease that has continued to spread over time and it is a reality that there are large populations where HIV is very common.
Without the need to delve into statistics and percentages of this disease, I think it is a very important issue to address for those who suffer from it, since, like diabetics or hypertensives, they can also mistakenly assume that due to their disease, they cannot be subjected to a weight loss procedure.
This topic can be divided into several answers which we will give below:
The proportion of people who are obese or overweight and who have HIV has increased since the use of antiretroviral therapy was introduced. Recent studies reveal that current antiretroviral drug regimens with the use of very specific drugs such as strain transfer inhibitors of integrase and tenofovir alafenamide contribute to weight gain, however, the mechanisms by which this happens are still unknown.
An alteration in metabolic regulation is linked to the presence of the adipose immune cell population and the accumulation of ectopic fat (fat outside its usual site) in those patients with HIV and obesity, thus contributing to an increase in the burden of metabolic disease in the population living with HIV. For this reason, this topic becomes relevant when it is well-known that metabolic or obesity surgery is an excellent tool to improve the general state of health of patients.
As we mentioned before, after analyzing the effects of bariatric surgery on HIV for several years, it has been concluded that there is no contraindication for its performance. As always, each case must be analyzed individually since it is not possible to make a recommendation without an exhaustive evaluation of the case.
Medically speaking, the main reason why it was considered prudent to investigate how bariatric surgery might affect HIV patients and whether it was feasible was because the gastric sleeve is the most frequently performed procedure worldwide for weight loss. weight and metabolic control, with gastric bypass in second place.
In both procedures, a modification is made to a greater or lesser degree of the gastrointestinal tract, this modification being greater in gastric bypass. However, despite these modifications and after years of research, it was shown that there is no alteration in the absorption of antiretroviral drugs in patients with HIV, which is why it is considered very safe for the metabolic control and obesity of the patient. .
The precautions to be taken are practically the same for the patient with HIV, the care must be the same, so it is necessary to remain alert to the possible complications that could occur in any patient, whether or not they have HIV.
A clear contraindication would be if the patient shows signs that HIV is not controlled, that is, their cd4 cell count or viral load is not adequate, or begins to show signs or symptoms of acquired immunodeficiency syndrome. Apart from this situation, there is no other contraindication. At least in our practice, this has not been the case.
The precautions to take are based on the aforementioned: having recent studies that show that their immunity is intact with an adequate cd4 count and viral load and that there is no associated acute illness such as gastrointestinal infection, fever, or infection of the respiratory tract, etc.
There are few cases where this situation has occurred, but the recommendations are the same as for a patient without this condition:
Have a complete evaluation with the entire team of the bariatric center of your choice.
At least have the evaluation by internal medicine with all the relevant studies for your particular case.
Psychological evaluation and a nutritionist.
Adequate follow-up for a considerable time as in any bariatric patient.
Speaking of other autoimmune diseases, there is a huge number of particular situations in each one of them, so it would be ideal to talk about each one in detail.
As they are rare diseases, there may be no experience with the subject of bariatric surgery; however, to answer this question specifically:
IT is possible to operate on patients with diseases such as:
The key will be the personalized evaluation of each case to ensure the success of the surgery and the appropriate evolution of the patient.
Come with us to review your particular case, resolve your doubts and advise you on your best option.
Source:
The effect of bariátric surgery on HIV patients
https://pubmed.ncbi.nlm.nih.gov/29948874/
Comparative Outcomes of Bariatric Surgery in Patients With and Without Human Immunodeficiency Virus
https://pubmed.ncbi.nlm.nih.gov/29127578/
Weight Gain and Metabolic Syndrome in Human Immunodeficiency Virus Patients
https://pubmed.ncbi.nlm.nih.gov/35706080/
Obesity and Weight Gain in Persons with HIV
https://pubmed.ncbi.nlm.nih.gov/32072466/
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