1527. Virologic Outcomes of Antiretroviral Therapy in HIV-1 Infected Patients Following Bariatric Surgery: A case series
Session: Poster Abstract Session: HIV: Clinical Care
Friday, October 28, 2016
Room: Poster Hall
Background:

Alterations in the surface area and pH of the gastrointestinal tract following bariatric surgery (BS) may impact absorption of antiretroviral therapy (ART) and virologic suppression. Data on the efficacy and tolerability of ART in HIV-infected patients who have undergone BS are limited or lacking for newer antiretrovirals (ARVs), such as dolutegravir (DTG). The aim of our analysis was to assess virologic suppression and ART tolerability following BS.

Methods:

A retrospective case series of 7 morbidly obese HIV-infected patients receiving ART who underwent BS.

Results:

Of 7 patients identified with a median treatment duration of 9 months, 3 underwent sleeve gastrectomy and 2 each underwent gastric banding or bypass. Virologic suppression was achieved with 8 out of 9 ART regimens (88.9%) administered following BS with 1 patient experiencing virologic failure due to ART-intolerance (nausea/vomiting) requiring ART change. Virologic suppression was achieved with all 6 of the DTG-containing regimens (Table 1). 

Conclusion:

The majority of ART regimens administered after BS were well-tolerated and effective in achieving virologic suppression. To our knowledge, this is the first reported data on the efficacy of DTG-containing regimens in patients who have undergone BS. Further studies are needed to determine the pharmacokinetic and long-term virologic effects of ART following BS.

Table 1

Patient #

1

2

3

4

5

6

7

Age1 (yr)

41

53

55

22

50

30

46

Gender

F

F

F

M

M

F

F

BMI, pre-op

(kg/m2)

53.0

51.1

48.5

-

45.5

63.0

53.1

BMI, post-op

(kg/m2)

46.0

45.3

34.1

26.9

32.9

66.0

37.8

Procedure

AGB

RYGB

SG

RYGB

SG

AGB

SG

Archived Genotypes

-

-

K103N

-

K103N, P225H, M184I, M184V, M41L, Y115F, L63P, D60E

-

K70E, Y115F, E138Q, Y181C, M184V, H221Y

Post-Op

Regimen #1

ATV, RTV, FTC, TDF

NVP, ABC, 3TC

DTG, ABC, 3TC

DTG, FTC, TDF

ETR, RAL, TDF

DTG, FTC, TDF

DRV, RTV, FTC, TDF, DTG

HIV RNA,

(copies /mL)

360

< 20

< 20

< 20

< 20

< 20

< 20

Post-Regimen #2

DTG, 3TC, RPV

-

-

-

DRV, RTV, FTC, TDF, DTG

-

-

HIV RNA

(copies/mL)

< 20

-

-

-

< 20

-

-

1At time of surgery

ABC-abacavir;AGB-Adjustable gastric banding;ATV-atazanavir;DRV-darunavir;DTG-dolutegravir;ETR-etravirine;F-female;FTC-emtricitabine;M-male;NVP-nevirapine;RAL-raltegravir;RPV-rilpivirine;RTV-ritonavir;RYGB-Roux-en-Y gastric bypass;SG – sleeve gastrectomy;TDF-tenofovir disoproxil fumarate;3TC-lamivudine

Melissa Badowski, PharmD1, Sally Kassem, PharmD Candidate2, Christopher Taylor, PharmD Candidate2, Lacie Mckamey, PharmD3, Jennifer Janelle, MD2, Ernesto Lamadrid, MD4, Kristen Bunnell, PharmD1 and Emily Huesgen, PharmD5, (1)Pharmacy, University of Illinois at Chicago, Chicago, IL, (2)University of Florida, Gainesville, FL, (3)Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL, (4)Department of Health, Gainesville, FL, (5)Pharmacy, University of Florida, Gainesville, FL

Disclosures:

M. Badowski, None

S. Kassem, None

C. Taylor, None

L. Mckamey, None

J. Janelle, None

E. Lamadrid, None

K. Bunnell, None

E. Huesgen, None

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