Review Article
Year: 2023 | Month: September | Volume: 13 | Issue: 9 | Pages: 150-156
DOI: https://doi.org/10.52403/ijhsr.20230922
Review on Antiretroviral Considerations in HIV-Infected Patients Undergoing Bariatric Surgery
B Deepika1, G Ramya Balaprabha2
1,2Department Pharm D, CMR College of Pharmacy, Hyderabad, India
Corresponding Author: XYZ
ABSTRACT
Bariatric surgery is a widely accepted method for promoting weight loss in individuals with obesity, including those who are living with HIV. However, there are specific challenges and factors to consider when it comes to managing antiretroviral therapy (ART) for HIV-infected patients undergoing bariatric surgery. This comprehensive review aims to provide a detailed overview of the current evidence and recommendations regarding the use of antiretroviral drugs in this population. Obesity is prevalent among people living with HIV, and bariatric surgery has proven to be an effective approach for achieving long-lasting weight loss and improving metabolic parameters. Nevertheless, it is crucial to carefully evaluate how bariatric surgery may affect the absorption, distribution, metabolism, and interactions of antiretroviral drugs. The changes in the gastrointestinal anatomy and physiology that result from bariatric surgery can impact drug absorption, potentially leading to insufficient exposure to antiretroviral medications and treatment failure. This review specifically examines the pharmacokinetic considerations for commonly used antiretroviral drug classes in HIV management, such as protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitors. It discusses the potential changes in drug absorption, distribution, and metabolism that can occur after bariatric surgery and provides guidance on adjusting therapy based on individual patient characteristics, the type of surgical procedure, and possible drug interactions. Effective management of HIV-infected patients undergoing bariatric surgery requires close collaboration among HIV specialists, bariatric surgeons, and pharmacists. Monitoring virological and immunological markers, such as viral load and CD4 cell count, is essential to ensure treatment effectiveness and detect possible treatment failure. Further research is necessary to establish evidence-based guidelines for optimizing ART in this unique patient population. In conclusion, this review underscores the importance of considering the management of antiretroviral therapy in the context of bariatric surgery for individuals living with HIV. It highlights the significance of tailoring treatment approaches to individual patients and fostering interdisciplinary collaboration to achieve the best treatment outcomes and long-term health for this population.
Key words: HIV, bariatric surgery, antiretroviral therapy, drug absorption, drug interactions, dosing strategies, weight loss, pharmacokinetics.