Dolutegravir plasma levels after gastric bypass surgery

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With successful combined antiretroviral therapy, HIV-infected individuals are increasingly overweight or obese at a rate similar to the general population [1]. As a consequence, bariatric surgery is also performed in HIV-infected individuals to obtain long-term weight loss and thereby prevent complications such as diabetes and cardiovascular diseases. Gastric bypass surgery is currently considered as the best treatment option for morbid obesity in international guidelines for the general obese population [2]. The Roux-en-Y gastric bypass is a common procedure consisting of creating a small portion of the stomach and attaching it directly to the small intestine, thereby causing a substantial amount of food to bypass the stomach and the upper intestine and not be absorbed [3]. As a consequence, this procedure has also the potential to alter the absorption of drugs which, in the case of antiretroviral drugs, can have deleterious implications on the virological suppression. Thus, the measurement of antiretroviral drug levels is of utmost importance to characterize the impact of bariatric surgery on antiretroviral drug absorption and thereby provide guidance on how to adjust dosage to maintain optimal antiretroviral drug coverage.
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