PRELIMINARY COMMUNICATION Metformin in the Treatment of HIV Lipodystrophy Syndrome A Randomized Controlled Trial

ALIPODYSTROPHY SYNDROMEcharacterized by fat redistri-bution, including accumula-tion of truncal fat and loss of extremity and facial fat, has been rec-ognized increasingly among patients infected with human immunodefi-ciency virus (HIV), particularly in those receiving combination antiretroviral therapy.1-6 Mounting evidence indi-cates that HIV lipodystrophy syn-drome is also associated with signifi-cant insulin resistance.7-12 In non–HIV-infected patients, insulin resistance and hyperinsulinemia are independent risk factors for coronary artery disease (CAD).13-15 Similarly, as patients with HIV infection live longer, hyperinsu-linemia and insulin resistance may increase CAD risk in the expanding populationofHIV-infectedpatientswith lipodystrophy syndrome. We hypoth-esized that treatment with metformin, an insulin-sensitizing agent, would improve insulin resistance and overall cardiovascular risk profile in this popu-lation. We conducted a 3-month, ran-domized, double-blind, placebo-controlled pilot study to assess the safety and efficacy of metformin in HIV-infected patients with fat redistribution and abnormal glucose homeostasis