Benfluorex as a therapeutic option for insulin resistance in HIV lipodystrophy syndrome.
BACKGROUND
HIV lipodystrophy syndrome, characterized by a significant excess of visceral adiposity and a reduced subcutaneous fat mass in association with insulin resistance and dyslipidemia, still affects the majority of antiretroviral-treated HIV-infected patients. The therapeutic management of this syndrome has not yet been well established. Benfluorex is known to decrease insulin resistance with no side effects on lactate levels in HIV-negative patients.


METHODS
We conducted an open-label study of benfluorex (150 mg, 2-3 times a day) that was prescribed for 60 HIV-infected patients who were diagnosed with glucose metabolism abnormalities by oral glucose tolerance test (OGTT); 47 of these patients had visceral fat accumulation measured by computed tomography (VAT). Median follow-up was 12 months (interquartile range [IQR] = 6-12 months). The great majority of patients (90%) were treated with at least triple therapy (in 70% the therapy included at least one PI), with a nonsignificant change over the study period.


RESULTS
Added to antiretroviral therapy, benfluorex improved OGTT in 47/60 cases, including total normalization in 34/60 without lactate concentration modification. A trend toward a decrease in VAT distribution was observed (p =.06). No significant difference was observed in subcutaneous fat distribution, although an increase in subcutaneous thigh adipose tissue was observed in 17/47 (36.2%) cases and 6 patients (12.7%) presented both subcutaneous fat increase and VAT decrease.
Poizot-Martin
I
I
CISIH-SUD, Clinical Research Department, Hôpital Sainte-Marguerite CHU, and INSERM U379, Marseille, France. isabelle.poizot@mail.ap-hm.fr
Marimoutou
C
C
Vion-Dury
F
F
Grégoire
R
R
Dinh
T
T
Djemli
K
K
Di Stefano
D
D
Vague
Ph
P
Gastaut
J A
JA
D000273:Adipose Tissue / Q000187:drug effects; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D005277:Fenfluramine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D005951:Glucose Tolerance Test; D039682:HIV-Associated Lipodystrophy Syndrome / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D000960:Hypolipidemic Agents; D005277:Fenfluramine; C001584:benfluorex