to determine HIV viral load and resting lactate levels. Waist-to-hip ratio, height, and weight were also measured, and a DEXA scan was used to assess body fat redistribution. Cardiovascular fitness was also tested. Patients were then randomised to receive treatment with metformin at a dose of 500mg twice daily, with dose escalation to 850mg twice daily after two weeks, or the same metformin regimen in combination with an exercise programme consisting of an hour of cardiovascular and weight training three times a week for twelve weeks.The two groups of patients had comparable insulin profiles and cardiovascular disease risk factors at baseline. A total of twelve patients (eight in the exercise group and four in the metformin only arm) withdrew from the study. One patient in each arm withdrew after increases in their resting lactic acid levels, and one patient from each group withdrew after abnormal liver function results.

Patients in the exercise arm experienced a greater fall in their median systolic (p=0.012) and diastolic (p=0.001) blood pressure than individuals in the metformin only arm. In addition, the waist-to-hip ratio improved to a greater extent in the exercise/metformin arm than in the metformin-only arm, as did the fasting insulin (p<0.05). Thigh muscle area increased to a greater extent in the exercise/metformin arm than in the metformin-only arm (p=0.015), and so did exercise time (p=0.045). Both subcutaneous adipose tissue (p=0.049) and visceral adipose tissue (p=0.063) tended to decrease in the exercise arm as opposed to the metformin-only arm. However, improvements in lipids and resting lactate were comparable between the two groups of patients. The investigators conclude that: “our study…suggests that a thrice-weekly aerobic and resistance training programme in combination with metformin significantly improves cardiovascular parameters and aerobic endurance in hyperinsulinemic, lipodystrophic HIV patients.” They caution, however, that metformin, combined with exercise, is not recommended for patients with lipoatrophy and insulin resistance, due to the potential for further weight loss. aidsmap.com, published by NAM
(published with permission in writing from:http://aidsmap.com)




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