May 21, 2004

Diabetes drug eases effects of HIV therapy

Use of an oral anti-diabetes medication produced significant improvement in a group of patients with HIV lipodsytrophy, a syndrome involving the redistribution of fat and other metabolic changes in those receiving combination drug therapy for HIV infection. In the May 18 Annals of Internal Medicine, MGH researchers report that daily doses of rosiglitazone (Avandia) improved insulin sensitivity and alleviated fat redistribution in patients with lipodystrophy and insulin resistance.

Although combination drug therapy can significantly reduce viral levels and help maintain health in HIV-infected individuals, a significant number can develop lipodystrophy. Symptoms of the syndrome may include a loss of subcutaneous fat in the face, arms and legs; increased fat deposits in the abdomen and upper back; changes in cholesterol and other blood lipids; and insulin resistance. "The metabolic complications of this condition are becoming more significant as patients spend more time on this treatment," says Colleen Hadigan, MD, MPH, of the MGH Neuroendocrine Unit and Program in Nutritional Metabolism, the report's lead author.

Since patients with HIV lipodystrophy may have a variety of symptoms, the current study was limited to participants who had developed insulin resistance. The 27 enrolled patients received daily doses of either rosiglitazone or a placebo. At the end of the three-month study period, those who received rosiglitazone were found to have a 20 percent improvement in insulin sensitivity and had significant increases in total body fat, particularly in their extremities.

"There still are a lot of questions to be answered about safety before these results can be widely applied," Hadigan says. "Larger and longer trials of this drug and related medications are needed to determine the best therapeutic approaches for individual patients."

Additional MGH study authors are Steven Grinspoon, MD, and Fiona Havers.