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Martínez, E. et al.

Martínez, Domingo, Ribera, Milinkovic, Arroyo, Conget, Pérez-Cuevas, Casamitjana, de Lazzari, Bianchi, Montserrat, Roca, Burgos, Arnaiz, Gatell,

Effects of metformin or gemfibrozil on the lipodystrophy of HIV-infected patients receiving protease inhibitors.

BACKGROUND: Hypertriglyceridaemia and insulin resistance are common in HIV-infected patients treated with protease inhibitors, particularly in those with lipodystrophy. Whether a therapeutic approach addressed to those metabolic abnormalities may have any impact on body fat is not clear. METHODS: Patients on stable antiretroviral therapy containing protease inhibitors, with abdominal obesity defined by increased waist-to-hip ratio, and plasma triglycerides >200 mg/dl, were randomized to receive blind medication consisting of metformin 850 mg, gemfibrozil 600 mg or placebo every 12 h for 1 year. Weight, height, waist and hip were measured, and fasting blood analyses, including at least CD4 cell count, plasma HIV-1 RNA, lactate, glucose, insulin, triglycerides, total, HDL and LDL cholesterol were performed at baseline and every 3 months. An oral glucose tolerance test, and assessments of total and regional fat by bioimpedance analysis and sonography, respectively, were also done at baseline, 6 and 12 months. RESULTS: One-hundred-and-eight patients were randomized to placebo (n=36), gemfibrozil (n=37) or metformin (n=35). There was absolute loss of total and regional fat in the three arms without significant changes in the waist-to-hip ratio. However, the loss of fat in patients on gemfibrozil was significantly lower than in patients on placebo. No patient discontinued study drugs due to adverse effects. CONCLUSION: In this population of HIV-infected patients, there was a loss of fat along time. The finding of relative preservation of fat associated with gemfibrozil therapy deserves further investigation in the search of potential effective therapies for lipodystrophy in HIV-infected subjects.[1]

References

Effects of metformin or gemfibrozil on the lipodystrophy of HIV-infected patients receiving protease inhibitors. Martínez, E., Domingo, P., Ribera, E., Milinkovic, A., Arroyo, J.A., Conget, I., Pérez-Cuevas, J.B., Casamitjana, R., de Lazzari, E., Bianchi, L., Montserrat, E., Roca, M., Burgos, R., Arnaiz, J.A., Gatell, J.M. Antivir. Ther. (Lond.) (2003) [Pubmed]

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