Metabolic Effects of Rosiglitazone in HIV Lipodystrophy

Patients with HIV infection who are treated with antiretroviral agents often lose subcutaneous fat and have metabolic abnormalities, including insulin resistance and reduced adiponectin levels, which may be related to disrupted subcutaneous adipogenesis and altered peroxisome proliferator-activated receptor-gamma signaling.

The aim of the current study was to investigate the effects of rosiglitazone (4 mg/d), a peroxisome proliferator-activated receptor-gamma agonist, in HIV-infected men and women with hyperinsulinemia and lipoatrophy.

The study enrolled 28 HIV-infected men and women with hyperinsulinemia and lipoatrophy and was designed as a randomized, double-blind, placebo-controlled, 3-month study at the Massachusetts General Hospital and Brigham and Women's Hospital in Boston, MA.

Insulin sensitivity was measured by euglycemic hyperinsulinemic clamp testing; subcutaneous leg fat area was measured by computed tomography; adiponectin, free fatty acid, and lipid levels; and safety variables.

Results

Rosiglitazone, when compared with placebo, improved insulin sensitivity, increased adiponectin levels, and reduced free fatty acid levels. Mean percentage (+/-SD) of body fat and subcutaneous leg fat area increased significantly with rosiglitazone compared with placebo.

Mean total cholesterol levels (+/-SD) also increased with rosiglitazone compared with placebo.

The study was relatively small and of short duration.

Conclusions

The authors demonstrated positive effects of rosiglitazone on lipoatrophy; insulin sensitivity; and metabolic indices, including adiponectin levels, in HIV-infected patients with lipoatrophy and insulin resistance.

The authors conclude, “Peroxisome proliferator-activated receptor-gamma agonists may correct the metabolic abnormalities associated with disrupted adipogenesis in this population. Further studies must determine the clinical utility of such agents in HIV-infected patients.”

[Note: For a not so rosy review of the effects of rosiglitazone on lipoatrophy, see a report from the 11 CROI in San Francisco by Andrew Carr—Ed]

05/26/04