Use of Thiazolidinediones in HIV-Infected Patients: What Have We Learned?

Extract

HIV-infected patients receiving highly active antiretroviral therapy often develop changes in fat distribution with loss of abdominal and peripheral subcutaneous fat, including increased visceral adiposity in some patients, and metabolic perturbations including insulin resistance and dyslipidemia. Thiazolidinediones (TZDs) stimulate glucose transport into muscle and simultaneously increase adipogenesis through effects on transcription of peroxisome proliferator-activated receptor—γ. TZDs might therefore be a potentially useful treatment strategy for HIV-infected patients with loss of subcutaneous fat and insulin resistance. Several studies have tested the hypothesis that TZDs would be clinically useful to treat subcutaneous fat loss in HIV-infected patients. Although some randomized studies have shown positive effects on subcutaneous fat loss in HIV-infected patients [1–4], others [5, 6], including the current study by Cavalcanti et al. in this issue of the Journal [7], do not show an effect. Why do these studies show different results, and, more fundamentally, are we looking at the correct end point, if we focus exclusively on fat loss?