Bariatric Surgery in Individuals with HIV and Type 2 Diabetes: A Case Series

<b>Background</b> The efficacy and safety of bariatric surgery have not been fully
elucidated in patients affected with HIV. Although adjustable gastric banding
(ABG) and sleeve gastrectomy (SG) are started to be used in HIV patients, there
are limited descriptions of the outcomes of T2DM in the HIV positive group
undergoing these procedures.

<b>Case presentation</b> We have evaluated retrospectively three patients
who underwent AGB or SG, the effect in weight reduction and glycaemic control as
well as its impact on the HIV management. Case 1 (AGB) achieved 19% total
weight loss (TWL) and Cases 2 and 3 (SG) lost 25% and 14% respectively
post-operation. In terms of T2DM, Case 2 achieved complete remission according
to ADA criteria, while Case 1 would also have achieved remission were it not
for the continuation of metformin postoperatively. Insulin requirements and
pill burden were markedly reduced in Case 3 after SG, though lack of remission
was predictable given the longevity of T2DM and pre-operative insulin dosage.
In all three cases, HIV status did not appear to be affected by the bariatric
surgery which was supported by the post-operative stable CD4 count and
undetectable viral load.

<b>Conclusions</b> Bariatric surgery is a safe and effective treatment
modality in the HIV positive patient with obesity and T2DM.

<b>背景</b> 减重手术在HIV感染患者中的疗效与安全性尚未得到充分阐明。尽管可调节胃束带术（adjustable gastric banding, AGB）和袖状胃切除术（sleeve gastrectomy, SG）已开始应用于HIV患者，但关于接受这些手术的HIV阳性人群中2型糖尿病（T2DM）转归的描述仍较为有限。

<b>病例报告</b> 我们回顾性评估了3例接受AGB或SG手术的患者，分析了手术在减重、血糖控制方面的效果及其对HIV管理的影响。病例1（AGB）实现了19%的总体重减轻（total weight loss, TWL），病例2和3（SG）术后分别减重25%和14%。在T2DM方面，病例2根据美国糖尿病协会（ADA）标准达到完全缓解；若病例1术后未继续服用二甲双胍，本也可实现缓解。病例3术后胰岛素需求和服药负担显著降低，但鉴于其T2DM病程较长及术前胰岛素剂量，未达缓解在意料之中。三例患者中，减重手术均未对HIV病情产生明显影响，这一点得到术后稳定的CD4细胞计数及不可检测的病毒载量的支持。

<b>结论</b> 减重手术是肥胖合并T2DM的HIV阳性患者的一种安全且有效的治疗方式。