Bariatric surgery is increasingly applied among people living with HIV to reduce obesity and the associated morbidity and mortality. In people living with HIV, sufficient antiretroviral exposure and activity should always be maintained to prevent development of resistance and disease progression. However, bariatric surgery procedures bring various gastrointestinal modifications including changes in gastric volume, and acidity, gastrointestinal emptying time, enterohepatic circulation and delayed entry of bile acids. These alterations may affect many aspects of antiretroviral pharmacokinetics. Some drug characteristics may result in subtherapeutic exposure and the potential related risk of treatment failure and resistance. Antiretrovirals that require low pH, administration of fatty meals, longer intestinal exposure, and an enterohepatic recirculation for their absorption may be most impacted by bariatric surgery procedures. Additionally, some antiretrovirals can interact with the polyvalent cations in supplements or drugs inhibiting gastric acid, thereby preventing their use as these comedications are commonly prescribed post-bariatric surgery. Predicting pharmacokinetics on the basis of drug characteristics solely proved to be challenging, therefore pharmacokinetic studies remain crucial in this population. Here, we discuss general implications of bariatric surgery on antiretroviral outcomes in people living with HIV as well as drug properties that are relevant for the choice of antiretroviral treatment in this special patient population. Additionally, we summarise studies that evaluated the pharmacokinetics of antiretrovirals post-bariatric surgery. Finally, we performed a comprehensive analysis of theoretical considerations and published pharmacokinetic and pharmacodynamic data to provide recommendations on antiretrovirals for people living with HIV undergoing bariatric surgery.

减肥手术越来越多地应用于艾滋病病毒感染者，以减少肥胖和相关的发病率和死亡率。在 HIV 感染者中，应始终保持足够的抗逆转录病毒暴露和活性，以防止产生耐药性和疾病进展。然而，减肥手术会带来各种胃肠道改变，包括胃容量和酸度、胃肠道排空时间、肠肝循环和胆汁酸进入延迟。这些改变可能会影响抗逆转录病毒药代动力学的许多方面。一些药物特性可能导致亚治疗暴露和治疗失败和耐药的潜在相关风险。需要低 pH 值的抗逆转录病毒药物、高脂肪膳食、更长的肠道暴露时间、并且肠肝再循环以吸收它们可能受减肥手术程序的影响最大。此外，一些抗逆转录病毒药物可以与补充剂或抑制胃酸的药物中的多价阳离子相互作用，从而阻止它们的使用，因为这些药物通常在减肥手术后开出。仅根据药物特征预测药代动力学具有挑战性，因此药代动力学研究在该人群中仍然至关重要。在这里，我们讨论了减肥手术对 HIV 感染者抗逆转录病毒治疗结果的一般影响，以及与这一特殊患者群体选择抗逆转录病毒治疗相关的药物特性。此外，我们总结了评估减肥手术后抗逆转录病毒药物药代动力学的研究。