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Metformin and Rosiglitazone, Alone or in Combination, in HIV-Infected Patients With Insulin and Fat Abnormalities
This study has been completed.
Sponsored by: National Institute of Allergy and Infectious Diseases (NIAID)
Information provided by: National Institute of Allergy and Infectious Diseases (NIAID)
ClinicalTrials.gov Identifier: NCT00015691
  Purpose

The purpose of this study is to see whether metformin alone, rosiglitazone alone, or metformin and rosiglitazone together will lower insulin levels in the blood and decrease fat in the abdomen or other parts of the body.

Studies have shown that certain anti-HIV medications can cause a number of side effects, including high blood sugar (resulting from the body's failure to use insulin), high insulin, and excess fat build-up in the abdominal area. These side effects are known to increase the risk of heart disease. Metformin and rosiglitazone are 2 drugs that have been shown to lower insulin resistance and lessen abdominal fat in patients who are not HIV-infected. This study will investigate the use of these drugs in HIV-infected patients.


Condition Intervention
HIV Infections
Lipodystrophy
Hyperinsulinemia
Drug: Metformin hydrochloride
Drug: Rosiglitazone maleate

MedlinePlus related topics: AIDS
Drug Information available for: Insulin Metformin Metformin hydrochloride Rosiglitazone Rosiglitazone Maleate Dextrose
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Double-Blind, Safety Study
Official Title: A Randomized, Double-Blind, Placebo-Controlled Study of Metformin and Rosiglitazone, Alone or in Combination, in HIV-Infected Subjects With Hyperinsulinemia and Elevated Waist/Hip Ratio

Further study details as provided by National Institute of Allergy and Infectious Diseases (NIAID):

Estimated Enrollment: 105
Detailed Description:

Recent studies have documented hyperglycemia, insulin resistance, and glucose intolerance in a seemingly increasing proportion of patients with HIV infection. Other studies have described a variety of syndromes of fat accumulation and fat loss, including abdominal obesity. Although initially attributed specifically to protease inhibitors (PI), these abnormalities also have been observed in antiretroviral-experienced but PI-naive patients. Hyperinsulinemia and abdominal obesity are strong independent risk factors for coronary artery disease. In noninfected patients, metformin and thiazolidinediones have been shown to reduce insulin resistance by different mechanisms and also to reduce visceral adiposity. This study investigates the use of metformin and rosiglitazone, a member of the thiazolidinedione class, in HIV-infected patients with hyperinsulinemia and central fat accumulation.

At study entry, clinical and laboratory assessments are performed. A standard OGTT, with plasma samples drawn over 120 minutes, will be performed for glucose and insulin determinations. After completion of entry evaluations, patients are assigned randomly to 1 of 4 double-blinded treatment arms:

Arm A: Metformin plus rosiglitazone placebo. Arm B: Metformin placebo plus rosiglitazone. Arm C: Metformin plus rosiglitazone. Arm D: Metformin placebo plus rosiglitazone placebo. Patients who are still on study drugs at Week 16 (at either full or reduced dose) are switched to the open-label phase to receive the combination of metformin and rosiglitazone through Week 32. Patients have evaluations at Weeks 2, 4, 8, 12, 16, 18, 20, 24, 28, and 32. [AS PER AMENDMENT 02/05/02: Evaluations must be performed under fasting conditions.] Safety indices, fasting insulin and glucose levels, visceral [AS PER AMENDMENT 02/05/02: and subcutaneous abdominal] fat are assessed. [AS PER AMENDMENT 02/05/02: Patients who discontinue study treatment due to pregnancy during the study will have the Week 32 evaluations (except CT and DEXA scans).] [AS PER AMENDMENT 02/05/02: A mid-thigh measurement was added to the study as a secondary endpoint to look for changes in extremity subcutaneous fat from therapy with rosiglitazone. Rosiglitazone and other peroxisome proliferator-activated receptor (PPAR) gamma activators increase subcutaneous adipogenesis and may thus increase subcutaneous fat and improve insulin resistance in this way.]

  Eligibility

Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria

Patients may be eligible for this study if they:

  • Are HIV-positive.
  • Have a viral load (level of HIV in the blood) below 10,000 copies/ml, within 30 days before study entry.
  • Have a fasting blood insulin level at 15 micro IU/ml or greater; or a 2-hour insulin at least 75 micro IU/ml or greater following 75 g glucose load; or a 2-hour glucose greater than 140 mg/dl following 75 g glucose load AND fasting serum insulin at least 10 micro IU/ml or greater, within 30 days before study entry.
  • Meet physical restrictions based on the amount and location of body fat and also on height and weight.
  • Have noticed changes in the location of their body fat during the course of their HIV disease.
  • Are 18 to 65 years old.
  • Have taken the same anti-HIV drugs for at least 60 days before study entry and do not plan to change these drugs for the entire study.
  • If taking hormones, have been on the same treatment for at least 6 months before study entry and do not plan to change for the entire study. Hormones include birth control pills, estrogen, or progestin for women and testosterone for men. If hormones were taken and then stopped, the treatment must have ended at least 6 months before the patient enters the study.
  • Have a negative pregnancy test within 30 days before taking the study drugs, if female and able to have children.
  • Agree to avoid trying to become pregnant or causing someone to become pregnant. Agree not to donate sperm or participate in other fertilization procedures. If sexually active, agree to use [AS PER AMENDMENT 02/05/02: 1] effective method of birth control while taking the study medications and for at least 30 days after stopping the study medications. Women who are not able to give birth or whose male partner is sterile are not required to use birth control.
  • Several changes have been made to this study. In earlier versions, a fasting blood insulin above 15 micro IU/ml was the only level accepted. Now there are several other insulin/glucose levels included. In addition, the timing of pregnancy tests has changed from 14 days to 30 days.

Exclusion Criteria

Patients will not be eligible for this study if they:

  • Are allergic to metformin or rosiglitazone.
  • Are pregnant or breast-feeding.
  • Abuse drugs or alcohol.
  • Have diarrhea, nausea, or vomiting.
  • Have heart disease.
  • Are taking or have taken drugs to control blood sugar.
  • Have taken any of the following drugs within 6 months before study entry: high-dose estrogen, high-dose testosterone, high-dose testosterone gel, testosterone creams, growth hormone, steroids to increase body size, DHEA or androstenedione (sold over the counter), prednisone and other steroid drugs at high doses, drugs to increase appetite, experimental drugs to increase appetite or weight gain, drugs that affect the immune system, pentoxifylline, thalidomide, niacin (a multivitamin containing niacin is okay), hydroxyurea, and cimetidine.
  • Are taking ritonavir with simvastatin or lovastatin (drugs to lower cholesterol).
  • Are taking drugs not approved by the FDA or of unknown identity, in experimental studies.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00015691

  Show 34 Study Locations
Sponsors and Collaborators
Investigators
Study Chair: Kathleen Mulligan
Study Chair: Steven Grinspoon
  More Information

Haga clic aquí para ver información sobre este ensayo clínico en español.  This link exits the ClinicalTrials.gov site

Publications:
Study ID Numbers: ACTG A5082, AACTG A5082
Study First Received: May 1, 2001
Last Updated: August 6, 2008
ClinicalTrials.gov Identifier: NCT00015691  
Health Authority: United States: Federal Government

Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):
Drug Therapy, Combination
Adipose Tissue
Area Under Curve
Hypoglycemic Agents
Anthropometry
Hyperinsulinemia
Metformin
BRL 49653
Insulin
Glucose Tolerance Test

Study placed in the following topic categories:
Sexually Transmitted Diseases, Viral
Metabolic Diseases
Skin Diseases
Metformin
Acquired Immunodeficiency Syndrome
Insulin
Immunologic Deficiency Syndromes
Virus Diseases
Hyperinsulinism
HIV Infections
Lipodystrophy
Sexually Transmitted Diseases
Metabolic disorder
Congenital Abnormalities
Glucose Metabolism Disorders
Rosiglitazone
Retroviridae Infections
Lipid Metabolism Disorders

Additional relevant MeSH terms:
RNA Virus Infections
Hypoglycemic Agents
Slow Virus Diseases
Immune System Diseases
Skin Diseases, Metabolic
Physiological Effects of Drugs
Lentivirus Infections
Infection
Pharmacologic Actions

ClinicalTrials.gov processed this record on January 16, 2009