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Comparison of Rosiglitazone and Metformin for Treatment of HIV-related
Lipodystrophy
The
use of antiretroviral
combination therapy in HIV has been associated
with the development of lipodystrophy
(subcutaneous fat
loss and/or visceral
fat accumulation) and cardiovascular
risk factors. As yet there is no known effective
therapy for HIV-related lipodystrophy.
In
the present study, an open, randomized, 6-month clinical trial conducted
in the Netherlands, researchers sought to compare the effects of
rosiglitazone and metformin
for treatment of HIV-associated lipodystrophy. The study
enrolled 39 HIV-infected men with lipodystrophy who received
8 mg/day rosiglitazone or 2 mg/day metformin.
Insulin
sensitivity was estimated by the oral glucose tolerance
test, subcutaneous and visceral abdominal fat was measured
by single-slice computed tomography, endothelial function
was measured by flow-mediated vasodilation, and fasting
plasma measurements.
Two patients
in the metformin group withdrew from the study.
Results
·
Compared
with metformin, rosiglitazone increased subcutaneous abdominal
fat (between-treatment change from baseline, 27 cm2)
and visceral abdominal fat (between-treatment change
from baseline, 24 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%) and not with rosiglitazone
(mean change, 0.7%);
·
The
metformin versus rosiglitazone increases did not statistically
differ;
·
Rosiglitazone
and metformin did not change C-reactive protein levels.
The authors conclude, “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.”
The
editors note that a limitation of the study was its small size and
that it did not assess clinical outcomes. They also note that the
findings of the study “do not establish whether rosiglitazone or
metformin better benefits HIV-infected patients with lipodystrophy.”
09/19/05
Reference
J P H van Wijk and others. Comparison of Rosiglitazone
and Metformin for Treating HIV Lipodystrophy: a Randomized Trial.
Annals of Internal Medicine 143(5): 337-346. September 6, 2005.
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