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Metabolic and Morphologic Effects of Benfluorex in 25 HIV-Infected Patients with Lipodystrophy I. POIZOT-MARTIN1, D. DI STEFANO LOUINEAU2, J. FABRE-MONGES1, T. DINH1, H. BELLON1, J. C. MANELLI3, P. H. VAGUE4, M. P. DROGOUL-VEY1, C. DHIVER1, K. MONTCERISIER1, and J. A. GASTAUT1.
1CISIH, Hosp. Ste. Marguerite; 2Inst. PaoliCalmettes; 3La Conception; and 4Hosp. La Timone, Marseille, France Objective: To evaluate the effects of benfluorex on both lipid,glucose metabolism and body fat distribution in HIV infected patients with lipodystrophy.
Methods: It is a prospective study. 25 patients have been evaluated, 16 Females (mean age: 38±9 (28-62), mean CD4 cells count: 500± 220 (105-905), mean viral load VL: 1646 ± 4050 copy/ml (11 <200), 9 Males (mean age : 43,5± 4,7 (39-50), mean CD4 cells count: 383± 219 (110-834), meanVL: 900 ±1938 copy/ml (7 <200).
Mean time to previous antiretroviral therapy is respectively 5,2 y ±2,9(1-11) and 4,22 y±1,8 (1-7) and to present treatment 12 months ±6,5 (2-2,16 y) and 11, 5±4,37 months (1-15 m). Laboratory measurements included serum glucose, insulin and C-peptide in the basal state and after 75 g oral glucose tolerance test (OGTT), cholesterol, triglycerides concentrations. Body composition has been measured by bioelectrical impedance and regional fat distribution by computed tomography at abdominal and mid-thigh level. Daily total caloric and nutrient intake were evaluated by dietetician. Resting energy expenditure with indirect calorimetry (deltatrac Datex).
Results: Antiretroviral therapy was maintained in all patients. Fasting plasma glucose was normal in all patients whereas impaired glucose tolerance was observed in 1 male and 5 females. Fasting plasma insulin was normal in 13/20 patients with insulinoresistance and/or diabete. HDL Cholesterol was <0,9 mmo/l in 7 males and <1,16 mmol/l in 9 females. Cholesterol was >6,3 mmol/l in 7 males and 4 females and triglycerides >1,96 mmol/l in 5 males and 7 females. OGGT in females was at baseline (n=14): Insulin: T0: 29,56UI; T120mn:200UI; at M2(n=11): Insulin: T0: 21,14UI; T120mn:60UI; at M6(n=5): Insulin: T0: 11,3UI; T120mn:48,23UI. OGGT in males was at baseline (n=6): Insulin: T0: 19,45UI; T120mn:103,25UI; at M2(n=4): Insulin: T0: 12,82UI; T120mn:61,3UI. Mean values of the Subcutaneous (S) and Visceral (V) abdominal fat areas, S:V ratio and mid-thigh level was in females at baseline respectively (cm2) : 118, 6-138, 3-0, 95-34, 6 and at M6 : 114,8-138,3-1,08-33,1; in males, at baseline: 59,83-184,5-0,31-22,61 and at M6 :57-143,3-0,41-18,25. In females, Cholesterol T baseline: 5,91 mmole/l to 6,35 at M6; In males: 6,33 to 5,74 mmole/l; Triglyceride baseline: in females: 2,03 to 2,11 mmole/l; In males: 4,3 to 3,16 mmol/l
Conclusion: Benfluorex is effective on impaired glucose tolerance and insulinoresistance. The effects on lipid metabolism is inconstant. Up to now, no reversibility on fat distribution has been observed. Study is ongoing.
Key Words: BENFLUOREX, INSULINORESISTANCE, LIPODYSTROPHY
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