July 28, 2000

Diabetes drug may help to treat AIDS-related syndrome

A pilot study using metformin, a drug used to treat type 2 diabetes, indicates that the medication may be useful in treating HIV lipodsytrophy, a disorder of fat metabolism that occurs in people with AIDS, particularly those taking combination antiretroviral treatment. The trial in a group of patients with HIV and lipodystrophy, conducted by MGH researchers, appears in the July 26 Journal of the American Medical Association.

HIV lipodystrophy is characterized by abnormal fat distribution on the body combined with metabolic changes such as insulin resistance and elevated levels of cholesterol and triglycerides. Patients with HIV lipodystrophy may be at increased risk for cardiovascular disease, and there currently is no treatment for the condition.

In this three-month, double-blinded study, the MGH team examined the effects of the insulin-sensitizing agent metformin on several metabolic and cardiovascular measurements. Among the patients taking metformin, insulin levels dropped by an average of 20 percent (elevated insulin levels are an indication of insulin resistance), while patients taking a placebo showed no significant changes. Those receiving the drug also showed significant reductions in weight, blood pressure and abdominal fat, and there were indications of possible benefits in blood sugar and lipid (triglyceride) levels.

Steven Grinspoon, MD, of the MGH Neuroendocrine Unit, the paper's senior author, says, "The results are promising, but longer-term studies with larger groups of patients are needed to better understand which patients might benefit from metformin, what the long-term cardiovascular benefits might be, and whether other measures – such as dietary change – would also be helpful." Grinspoon's co-authors are first author Colleen Hadigan, MD, and Colleen Corcoran, NP, of the MGH Neuroendocrine Unit; Nesli Basgoz, MD, and Benjamin Davis, MD, of the MGH Infectious Disease Unit; and Paul Sax, MD, of the BWH Division of Infectious Diseases.