October 2000 Cover
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Lipodystrophy, or fat redistribution and insulin resistance, is common in HIV-infected patients who are treated with combination antiretroviral drugs. These effects are also considered risk factors for coronary artery
disease, and as more HIV patients live longer, they can face heart problems.
A study of 26 HIV patients who are non-diabetic and have fat redistribution evaluated the use of treatment with metformin, an insulin-sensitizing agent. Patients were given either 500 mg of metformin twice
a day or a placebo for three months. According to the results, metformin therapy led to lower insulin levels, significant weight loss, and decreased diastolic blood pressure. The drug had no effect on waist-hip ratio,
energy intake, HIV viral load, or cholesterol. Few adverse effects occurred, with mild diarrhea the most frequently reported. The authors conclude that low doses of metformin can reduce insulin resistance and improve signs
of lipodystrophy with high levels of tolerance among the subjects. More research is needed to determine the effects for HIV patients over the long term.
Editor's Note: from JAMA
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