Rosiglitazone with insulin resistance

A study of rosiglitazone (a thiazolidinedione agonist of PPAR gamma) at a dose of 4mg/day for three months followed by 8mg/day for a further three months in 28 patients with hyperinsulinaemia and lipoatrophy led to increases in subcutaneous and total body fat, but fasting triglycerides and cholesterol also increased. [17]

Previous studies using rosiglitazone in HIV-positive patients with lipodystrophy have not reported a benefit but this could be an option that helps those who also have insulin resistance.

A separate study from Oette and colleagues reported interaction data on ARVs and rosiglitazone [18] suggesting bioavailability of nevirapine could be reduced (AUC, Cmax and Cmin all by 30-35%) and that individualised dosing using therapeutic drug monitoring was recommended. Rosiglitazone did not produce clinically significant interactions with efavirenz, lopinavir or nelfinavir and no recommendation was given for saquinavir, although these results are limited by the low numbers studies for most of these drugs.

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Rosiglitazone increases cholesterol and triglycerides whereas pioglitazone does not, however the manufacturer Takeda has no interest in HIV and because of this the data are limited (see pilot study by Calmy, Hirshel et al - AIDS 2003; 17(5):770-772).

	HIV Treatment Bulletin Vol 4 No7 August / September 2003