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Comparison of Rosiglitazone and Metformin for Treating HIV Lipodystrophy: A Randomized Trial

Jeroen P.H. van Wijk, MD; Eelco J.P. de Koning, MD, PhD; Manuel Castro Cabezas, MD, PhD; Jos op't Roodt, BSc; Jorge Joven, MD, PhD; Ton J. Rabelink, MD, PhD; and Andy I. Hoepelman, MD, PhD
[+] Article and Author Information

From University Medical Center, Utrecht, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands; St. Franciscus Gasthuis, Rotterdam, the Netherlands; and Centre de Recerca Biomèdica, Hospital Universitari de Sant Joan, Reus, Spain.


Trial ISRCTN36766542

Acknowledgments: The authors thank Dr. E.P. Martens (Centre for Biostatistics, University of Utrecht, Utrecht, the Netherlands) for his help with the statistical analysis and Dr. R. van de Geest (Leiden University Medical Center, Leiden, the Netherlands) for his help with the reading and analysis of the computed tomography images.

Grant Support: By an unrestricted grant from GlaxoSmithKline. Dr. van Wijk has received educational grant support from the Dutch Organization for Scientific Research, and Dr. de Koning is recipient of a Career Development Grant from the Dutch Diabetes Research Foundation.

Potential Financial Conflicts of Interest: Grants received: J.P.H. van Wijk (Dutch Organization for Scientific Research), E.J.P. de Koning (Dutch Diabetes Research Foundation).

Requests for Single Reprints: Jeroen P.H. van Wijk, MD, Departments of Infectious Disease and Internal Medicine, University Medical Center, Room G02.402, PO Box 85500, 3508 GA Utrecht, the Netherlands; e-mail, j.p.h.vanwijk@azu.nl.

Current Author Addresses: Drs. van Wijk and Hoepelman: Departments of Infectious Disease and Internal Medicine, University Medical Center, Room G02.402, PO Box 85500, 3508 GA Utrecht, the Netherlands.

Drs. de Koning and Rabelink and Mr. op't Roodt: Departments of Nephrology, Leiden University Medical Center, Room C3-P, PO Box 9600, 2300 RC Leiden, the Netherlands.

Dr. Castro Cabezas: Departments of Internal Medicine, St. Franciscus Gasthuis, PO Box 10900, 3004 BA Rotterdam, the Netherlands.

Dr. Joven: Centre de Recerca Biomedica, Hospital Universitari de Sant Joan, C. Sant Joan s/n, 43201 Reus, Catalonia, Spain.

Author Contributions: Conception and design: J.P.H. van Wijk, E.J.P. de Koning, M. Castro Cabezas, T.J. Rabelink, A.I. Hoepelman.

Analysis and interpretation of the data: J.P.H. van Wijk, E.J.P. de Koning, M. Castro Cabezas, J. op't Roodt, J. Joven, T.J. Rabelink.

Drafting of the article: J.P.H. van Wijk, E.J.P. de Koning, M. Castro Cabezas, J. Joven, T.J. Rabelink, A.I. Hoepelman.

Critical revision of the article for important intellectual content: J.P.H. van Wijk, E.J.P. de Koning, M. Castro Cabezas, J. op't Roodt, T.J. Rabelink.

Final approval of the article: J.P.H. van Wijk, E.J.P. de Koning, M. Castro Cabezas, J. op't Roodt, J. Joven, T.J. Rabelink, A.I. Hoepelman.

Provision of study materials or patients: J.P.H. van Wijk, J. op't Roodt, A.I. Hoepelman.

Statistical expertise: J.P.H. van Wijk, J. Joven, A.I. Hoepelman.

Obtaining of funding: J.P.H. van Wijk, E.J.P. de Koning, M. Castro Cabezas, T.J. Rabelink, A.I. Hoepelman.

Administrative, technical, or logistic support: J.P.H. van Wijk, J. op't Roodt, J. Joven, A.I. Hoepelman.

Collection and assembly of data: J.P.H. van Wijk, A.I. Hoepelman.


Ann Intern Med. 2005;143(5):337-346. doi:10.7326/0003-4819-143-5-200509060-00009
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Lipodystrophy is a major clinical health problem in HIV-infected patients (24). We compared the effects of rosiglitazone and metformin for treating HIV lipodystrophy. Our findings emphasize the importance of individualized care in HIV-infected patients. Although rosiglitazone may partly correct lipoatrophy, metformin improves visceral adiposity, lipid profile, and endothelial function.

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Figures

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Figure 1.
Flow diagram of patients in the study.

HAART = highly active antiretroviral therapy.

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Figure 2.
Effects of rosiglitazone and metformin on insulin sensitivity.topmiddleFFAbottomAUC

Levels of plasma glucose ( ), insulin ( ), and free fatty acid ( ) ( ) after an oral glucose tolerance test are shown. Circles indicate rosiglitazone, and squares indicate metformin. Solid symbols indicate before treatment, and open symbols indicate after treatment. In the right panels, individual changes in the area under the curve ( ) are shown, and the horizontal lines represent the mean change in the area under the curve.

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Figure 3.
Effects of rosiglitazone and metformin on body fat distribution.solid lines

Individual changes in subcutaneous and visceral abdominal fat are shown. Circles indicate rosiglitazone, and squares indicate metformin. Open symbols represent the patients receiving stavudine treatment. Mean changes from baseline are shown ( ).

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Figure 4.
Effects of rosiglitazone and metformin on endothelial function.FMDsolid lines

Individual changes in fasting and postprandial flow-mediated vasodilation ( ) are shown. Circles indicate rosiglitazone, and squares indicate metformin. Open symbols represent the patients receiving lipid-lowering therapy. Mean changes from baseline are shown ( ).

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Summary for Patients

HIV Lipodystrophy: Rosiglitazone or Metformin?

The summary below is from the full report titled “Comparison of Rosiglitazone and Metformin for Treating HIV Lipodystrophy. A Randomized Trial.” It is in the 6 September 2005 issue of Annals of Internal Medicine (volume 143, pages 337-346). The authors are J.P.H. van Wijk, E.J.P. de Koning, M. Castro Cabezas, J. op't Roodt, J. Joven, T.J. Rabelink, and A.I. Hoepelman.

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