Metformin might be useful in treating HIV-associated lipodystrophy, according to a US study. It found that treatment with low-dose metformin had beneficial effects on weight, blood pressure and insulin levels.
Dr Colleen Hadigan (neuroendocrine unit, Massachusetts general hospital, Boston) and colleagues conducted a randomised, double-blind, placebo-controlled trial. Fourteen patients received 500mg metformin twice daily and 12 were given placebo for three months. The results showed that metformin reduced insulin levels, caused significant weight loss, decreased diastolic blood pressure and decreased visceral abdominal fat. The drug was generally well tolerated, although mild gastrointestinal symptoms were common, most of which resolved within four weeks. Metformin was not associated with increased lactate levels or liver dysfunction.
Lipodystrophy is characterised by fat redistribution from the extremities and face to the abdomen. It is associated with insulin resistance and, possibly, with increased risk of coronary heart disease. The condition occurs particularly in patients receiving a combination of antiretroviral drugs. The authors conclude that larger, long-term trials of insulin-sensitising agents, including metformin, in the treatment of lipodystrophy are now needed (Journal of the American Medical Association 2000;284:472).