Source/Disclosures
Disclosures: Pai and Routy report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
August 18, 2020
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Diabetes drug metformin decreases weight in people with HIV

Source/Disclosures
Disclosures: Pai and Routy report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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The antidiabetic drug metformin decreases weight and modifies the gut microbiota in patients with HIV who do not have diabetes, according to a study published in Open Forum Infectious Diseases.

“Weight gain and obesity are escalating global health concerns contributing to morbidity via increased risk of cardiovascular disease, diabetes, nonalcoholic steatohepatitis and cancer,” Jean-Pierre Routy, MD, professor of medicine at McGill University in Montreal, and colleagues wrote.

Gitanjali Pai HIV weight pullquote

Routy and colleagues recruited 23 people with HIV but not diabetes who were receiving ART for 2 or more years with a low CD4/CD8 ratio. They collected blood and stool samples during the patients’ initial study visit, after a 12-week metformin treatment and 12 weeks after discontinuation of the study. They then examined microbiota composition using 16S rDNA gene sequencing and searching for inflammation markers in blood plasma.

Metformin decreased patient weight, and weight loss had an inverse correlation with blood plasma levels of growth differentiating factor-15, which promotes satiety, according to the study. The researchers also discovered that metformin increased the amount of anti-inflammatory bacteria in the gut microbiota of participants. No serious adverse events were reported in any of the patients.

“Metformin wears a myriad of hats while influencing several physiologic processes in the body, as outlined in this study. While metformin influencing gut microbiota is not a new phenomenon in itself, its role in nondiabetic ART-treated patients living with HIV has not been defined as yet,” Infectious Disease News Editorial Board Member Gitanjali Pai, MD, AAHIVS, an infectious diseases specialist at Memorial Hospital in Stilwell, Oklahoma, told Healio.

“As the first study investigating the impact of metformin on weight, inflammation and gut microbiota composition in nondiabetic ART-treated patients with HIV, this study certainly opens up new avenues and vistas for desirable weight loss and change in gut microbiome composition in these patients.”

Pai noted that clinicians have also focused on strategies like improving gut barrier integrity to help patients with HIV maintain a healthy weight.

“Currently, HIV clinicians have endorsed modalities that promote weight loss in their patients, including diet modification, fostering healthy habits, lifestyle modification and targeted weight management programs, amongst others,” she said. “Studies also include innovative approaches, such as online weight loss programs, that have been shown to help overweight and obese patients with HIV lose weight.”

Previous research also indicates that weight gain is common among treatment-naive patients with HIV who initiate ART.

“Future studies should include a placebo arm, accounting for diet and physical activity,” Routy and colleagues wrote. “As weight gain was predominantly observed in women of African descent taking ART, a comprehensive view of metformin’s effect on this population will be required in large, randomized control trials. In addition, animal models would help deciphering the mechanisms of metformin-induced microbiota modification influence on weight and inflammation.”

Pai agreed that future randomized trials for metformin would be useful.

“With the gut microbiome and pathogenesis of HIV essentially being a two-way street, studies looking into various treatment strategies focusing on correcting dysbiosis and thus improving the overall health and well-being of HIV-1-infected individuals are of prime importance,” Pai said.