5th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 8–11 July 2003, Le Meridien Montparnasse, Paris, France

EFFECTS OF EXERCISE TRAINING AND METFORMIN ON BODY COMPOSITION AND CARDIOVASCULAR INDICES IN HIV-INFECTED PATIENTS

Antiviral Therapy 2003; 8:L7 (abstract 4)

SD Driscoll¹, G Meininger¹, M Lareau², SE Dolan¹, KM Killilea¹, C Hadigan¹, D Lloyd-Jones³, A Klibanski⁴, WR Frontera⁵ and S Grinspoon^1,4
1Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, MA, USA; ²Physical Therapy Services, Massachusetts General Hospital, Boston, MA, USA; ³Cardiology, Massachusetts General Hospital, Boston, MA, USA; ⁴Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA; and ⁵Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA

OBJECTIVES: Highly active antiretroviral therapy (HAART) is associated with fat redistribution and insulin resistance. Metformin has been shown to improve insulin and select cardiovascular risk markers in this population. Exercise training is known to improve cardiovascular indices among non-HIV patients. Exercise training in combination with metformin may further improve cardiovascular risk indices in comparison to metformin alone among HIV-infected patients.

METHODS: We conducted a prospective, randomized, 3-month study comparing the effects of metformin 850 mg twice daily versus metformin and exercise training in HIV patients on stable HAART, with hyperinsulinaemia and/or impaired glucose tolerance, and evidence of fat redistribution (waist-to-hip ratio >0.90 in men and >0.85 in women). Exercise consisted of 1 hour of aerobic and strength training 3 times a week.

RESULTS: Thirty-seven patients were randomized and 25 subjects completed the study. Subjects receiving exercise training and metformin demonstrated significant decreases in median waist-to-hip ratio [–0.02 (–0.06, –0.01) versus –0.01 (0.03, 0.02), P=0.026], resting systolic [–12 (–20,–4) versus 0 (–11, 11), P=0.012] and diastolic [–10 (–14, –8) versus 0 (–7, 8), P=0.001] blood pressures, increased thigh muscle cross-sectional area [3 (–3, 12) versus –7 (–11 ,0), P=0.015] and improved aerobic capacity (time on exercise bike) [3 (0, 4) versus 0 (–1, 1), P=0.045] compared to subjects receiving metformin alone. There were also increases in 5 out of 6 strength indices measured by one repetition maximum (P<0.05). Fasting insulin and insulin area under the curve (AUC) decreased significantly more in the exercise training and metformin group (P<0.05). Lipid and resting lactate did not change significantly between treatment groups.

CONCLUSIONS: These data demonstrate that exercise training in combination with metformin significantly improves cardiovascular risk markers more than metformin alone in HIV-infected patients with fat redistribution and hyperinsulinaemia. Exercise training was well-tolerated and improved muscle strength and size, as well as aerobic fitness. Combined therapy in selected groups of HIV-infected patients may substantially alter cardiovascular risk.

Presenting author: SD Driscoll

2003-07-08
4

Copyright © 2003 - International Medical Press Ltd.. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Medical Editor, International Medical Press, 36 St Mary-at-Hill, London EC3R 8DU, United Kingdom.