Important note: Information in this article was accurate in September 2000. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, September 4, 2000
Prepared by AIDS Weekly editors from staff and other reports
NewsRx -- Metformin may be of benefit to HIV patients with lipodystrophy syndrome, suggest the results of a clinical trial.
"Context A syndrome of lipodystrophy, characterized by fat redistribution and insulin resistance, has been estimated to affect the majority of HIV infected individuals who are treated with combination antiretroviral therapy," stated C. Hadigan and colleagues, Massachusetts General Hospital, Massachusetts. "There are no proven therapies for the metabolic disturbances associated with HIV lipodystrophy syndrome."
The researchers conducted a randomized, double-blind, placebo-controlled pilot study, therefore, assessing safety and efficacy of metformin in HIV patients who exhibited "fat redistribution and abnormal glucose homeostasis," they said. The study took place in a university hospital between December 1998 and January 2000. There were 26 HIV infected, nondiabetic patients with fat redistribution and abnormal oral glucose tolerance test (OGTT) results, hyperinsulinemia, or both, enrolled in the study.
The patients were randomly assigned to receive either metformin, 500 mg twice daily (n=14), or placebo (n=12), for three months. They calculated the insulin area under the curve (AUC) at 120 minutes following a 75 g OGTT at baseline before initiation of therapy and at a three-month follow-up. Data were compared between the two groups ("Metformin in the treatment of HIV lipodystrophy syndrome - A randomized controlled trial," JAMA 2000 Jul 26;284(4):472-7.
Hadigan and associates reported significant reductions in metformin-treated patients in the following respective measures:
"Metformin therapy was associated with a decrease in visceral abdominal fat (VAT; -1115 [819] vs. 1191 [699] mm2; P=.08) and a proportional reduction in subcutaneous abdominal fat (SAT); the VAT-SAT ratio was unchanged in metformin-treated vs placebo-treated patients."
Metformin treatment did not increase lactate or liver transaminase levels in the patients. The most common side effect was mild diarrhea and none of the patients discontinued therapy because of it.
"This study suggests that a relatively low dosage of metformin reduces insulin resistance and related cardiovascular risk parameters in HIV infected patients with lipodystrophy," concluded Hadigan et al.
The corresponding author for this report is S. Grinspoon, Massachusetts General Hospital, Neuroendocrine Unit, Bulfinch 457B, Boston, Massachusetts 02114, USA.
Key points reported in this study are:
This article was prepared by AIDS Weekly editors from staff and other reports.
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