Objective- To compare the effects of rosiglitazone (8 mg/d, n=19) and metformin (2 g/d, n=18) on postprandial lipemia in patients with HIV-lipodystrophy. Methods and results- Lipodystrophy in HIV is associated with insulin resistance and disturbed postprandial triglyceride and free fatty acid (FFA) metabolism. We conducted an open randomized 6-month study with standardized 10-h oral fat-loading tests at baseline and after treatment. Rosiglitazone (-34%) and metformin (-37%) reduced homeostasis model assessment similarly (P<0.05). Rosiglitazone did not change the area under the curve for FFA and triglyceride; however, it did reduce the area under the curve for hydroxybutyric acid (a marker of hepatic FFA oxidation) by 25% (P<0.05). Rosiglitazone increased the area under the curve for remnantlike particle cholesterol by 40% (P<0.01) compared with baseline. Metformin did not change any of the postprandial measurements. Conclusion- Rosiglitazone improved insulin sensitivity and decreased postprandial hydroxybutyric acid levels in patients with HIV-lipodystrophy, suggesting improved FFA handling. Despite metabolic improvements, rosiglitazone caused a marked increase in postprandial remnantlike particle cholesterol, which may adversely affect cardiovascular risk. Metformin did not affect postprandial lipemia and could be used to treat insulin resistance in this population.

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doi.org/10.1161/ATVBAHA.110.216192, hdl.handle.net/1765/34261
Arteriosclerosis, Thrombosis, and Vascular Biology
Erasmus MC: University Medical Center Rotterdam

van Wijk, J. P. H., Hoepelman, I. M., de Koning, E., Dallinga-Thie, G., Rabelink, T. J., & Castro Cabezas, M. (2011). Differential effects of rosiglitazone and metformin on postprandial lipemia in patients with HIV-lipodystrophy. Arteriosclerosis, Thrombosis, and Vascular Biology, 31(1), 228–233. doi:10.1161/ATVBAHA.110.216192