LAUSR

The impact of bariatric surgery on antiretroviral pharmacokinetics is poorly documented. Common surgical interventions for morbid obesity include diversionary procedures such as Roux-en-Y gastric bypass (RYGB) and restrictive procedures such as sleeve gastrectomy. Both procedures consist of creating a small portion of the stomach resulting in decreased gastric volume and increased gastric pH, which may impair the absorption of drugs whose solubility relies on low gastric pH (e.g. rilpivirine, atazanavir). In the case of RYGB, the gastric pouch is attached to the small intestine, thereby partially bypassing the duodenum and jejunum. Consequently, RYGB may further impact drug absorption due to a reduced exposure to the intestinal mucosa. Maintenance of sufficient antiretroviral drug exposure is critical given the risk of viral relapse. Thus, the characterization of antiretroviral drugs pharmacokinetics after bariatric surgery is of clinical interest to provide dosage recommendations both in the early and late postoperative periods.