Comparison of rosiglitazone and metformin for treating HIV lipodystrophy: a randomized trial.
BACKGROUND
The use of antiretroviral combination therapy in HIV has been associated with lipodystrophy and cardiovascular risk factors.


OBJECTIVE
To compare the effects of the peroxisome proliferator-activated receptor-gamma agonist rosiglitazone and metformin for treating HIV lipodystrophy.


METHODS
An open, randomized, 6-month clinical trial.


METHODS
University Medical Center, Utrecht, the Netherlands.


METHODS
39 HIV-infected men with lipodystrophy.


METHODS
Rosiglitazone, 8 g/d, or metformin, 2 g/d [DOSAGE ERROR CORRECTED]


METHODS
Insulin sensitivity estimated by the oral glucose tolerance test, subcutaneous and visceral abdominal fat measured by single-slice computed tomography, endothelial function measured by flow-mediated vasodilation, and fasting plasma measurements. Two patients in the metformin group withdrew from the study. Complete case analysis was performed.


RESULTS
Compared with metformin, rosiglitazone increased subcutaneous abdominal fat (between-treatment change from baseline, 27 cm2 [95% CI, 7 cm2 to 46 cm2]) and visceral abdominal fat (between-treatment change from baseline, 24 cm2 [CI, 6 cm2 to 51 cm2]). The area under the curve for insulin after the oral glucose tolerance test decreased similarly with both agents, but only rosiglitazone increased adiponectin levels. Metformin showed greater benefits on fasting lipid profile than rosiglitazone. Flow-mediated vasodilation statistically significantly increased with metformin (mean change, 1.5% [CI, 0.4% to 3.3%]) and not with rosiglitazone (mean change, 0.7% [CI, -1.1% to 2.7%]). The metformin versus rosiglitazone increases did not statistically differ. Rosiglitazone and metformin did not change C-reactive protein levels.


CONCLUSIONS
This small trial was not blinded or placebo-controlled and did not measure clinical outcomes.


CONCLUSIONS
The findings emphasize the importance of individualized care in HIV-infected patients. Although rosiglitazone may partly correct lipoatrophy, metformin improves visceral fat accumulation, fasting lipid profile, and endothelial function.
van Wijk
Jeroen P H
JP
Department of Infectious Disease, University Medical Center, Utrecht, The Netherlands. j.p.h.vanwijk@azu.nl
de Koning
Eelco J P
EJ
Cabezas
Manuel Castro
MC
op't Roodt
Jos
J
Joven
Jorge
J
Rabelink
Ton J
TJ
Hoepelman
Andy I
AI
D000273:Adipose Tissue / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001916:Brachial Artery / Q000502:physiology; D004730:Endothelium, Vascular / Q000378:metabolism; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005951:Glucose Tolerance Test; D015658:HIV Infections / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood; D008060:Lipodystrophy / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D047495:PPAR gamma / Q000819:agonists*; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000009:adverse effects / Q000627:therapeutic use*; D014664:Vasodilation / Q000187:drug effects
D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D007004:Hypoglycemic Agents; D007328:Insulin; D047495:PPAR gamma; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D008687:Metformin