Differential Effects of Rosiglitazone and Metformin on Postprandial Lipemia in Patients With HIV-Lipodystrophy

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. (Arterioscler Thromb Vasc Biol. 2011;31:228-233.)