Pathophysiological Study of Adipose Tissue of Patients Infected With HIV
Condition: HIV
Study type: Observational

Summary: 
      The main goal of our project is the study of subcutaneous and visceral (SAT and VAT) adipose
      tissue taken during bariatric surgery (Single port sleeve gastrectomy) of subjects with HIV
      infection, anf morbid obesity with undetectable viral load (VL) and having HIV
      lipohypertrophy particularly truncal. The study covers both the morphology of
      adipocytes,fibrosis, immune activation and inflammation, gene expression, pharmacology of
      antiretroviral drugs (ARV) and the measurement of viral replication in the adipose tissue and
      the plasma before and after bariatric surgery.
    

Detailed description: 
      The choice of the sleeve gastrectomy is based on choosing an effective technique with few
      complications, no rupture of digestive continuity and therefore little malabsorptive effect
      with a better quality of life.

      The intervention of sleeve gastrectomy offers a unique opportunity to study the SAT and VAT
      of HIV obese patients before and after bariatric surgery, to analyze the specific
      modifications of this tissue and to better understand the pathophysiology of this disease.
      The term associated with changes in cardiometabolic comorbidities and their improvement after
      weight loss will be important elements in the management of these patients. It is therefore
      important to evaluate whether the fibrosis term changes observed in HIV patients will change
      the effectiveness of the intervention.

      In the general population, obesity is a major public health problem. It is considered an
      inflammatory disease, multifactorial with chronic evolution, which requires long-term medical
      care and / or surgery . Indeed, the body mass index (BMI) correlates with increased mortality
      mainly due to cardiovascular diseases (hypertension, coronary artery disease), cancer and
      diabetes. Finally, overweight and obesity are the leading causes of liver disease in Western
      countries resulting in nonalcoholic fatty liver disease, a term that includes all the hepatic
      lesions observed in overweight and obesity: steatosis, steatohepatitis, fibrosis, cirrhosis
      or hepatocellular carcinoma. Nonalcoholic fatty liver disease reflects not only the presence
      of insulin resistance but also participates in its installation. Reducing overweight is
      therefore a key part of treatment to reduce chronic inflammation, insulin resistance and
      liver damage.

      There is little data in the literature on the prevalence of obesity in the population of HIV
      patients. In France, the prevalence of obesity in the French Hospital Database on HIV is
      15.1% among women and 5.3% among men, similar to prevalence in the general population.
      Patients born in sub-Saharan Africa have a higher risk with 20.7% versus 12.2% in women and
      10.9% versus 4.7% for men.

      No data is available on the obesity complications described in the general population in our
      population of obese HIV patients. Nevertheless, apart from obesity, patients infected with
      HIV develop cardiovascular and metabolic complications well documented in recent years.

      French and international recommendations agree that the management of obesity should be
      multidisciplinary. In the treatment, surgical treatment is the treatment of choice in French
      and international recommendations in the following indications:

        -  morbid obesity (BMI ≥ 40 kg / M²) resistant to medical treatment and exposing patients
           to serious complications that can not be controlled by the specific treatment

        -  obesity with BMI between 35 and 40 kg / M² with comorbidities associated with
           life-threatening or functional outcomes: cardiovascular disease, musculoskeletal
           disease, severe metabolic disorders not controlled by maximal medical therapy. In each
           case, the indication can be considered in patients who have had access to specialized
           medical care for at least 6 months, also including complementary approaches (diet,
           physical activity, management of psychological problems, treatment complications).

      At present, the sleeve gastrectomy is the technique of choice in the general population with,
      compared to other bariatric surgery techniques such as bypass, reducing complications, length
      of hospital stay, operative time, a gain in term quality of life without disruption of
      digestive continuity and therefore little or no malabsorption. This lack of malabsorption it
      an argument of choice in our HIV patients on cART with a reduced risk of malabsorption of ARV
      and vitamin deficiencies such as vitamin D deficiency already well described in HIV. The
      minimally invasive approach (1 trocar), routinely performed by Dr. G. Pourcher for obese
      patients whether they are infected with HIV, reduces surgical risk. This Single port also
      allows easy access to SAT, VAT and liver.

      The management of obesity in the HIV population, now having a similar life expectancy should
      be the same as that of the general population but remains to this day very marginal. The
      literature on the subject is almost "poor" Additionally, comorbid conditions existing in the
      population of HIV patients are a target population requiring support at least equivalent to
      that of the general population.
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Pathophysiology of adipose tissue of obese HIV-infected patients undergoing a sleeve
        gastrectomy using single port.

        20 patients will be required. Patients will be included after positive opinion of the
        multidisciplinary meeting of management of obesity.