Sitagliptin and HIV

BioMed Radio - Washington University School of Medicine in St. Louis

Patients with HIV are not in immediate danger of death anymore. Instead, thanks to antiretroviral therapy, most relatively live normal lives for many years. However, the combination of HIV and the drugs used to treat it leads many HIV-positive patients to develop lipid problems, diabetes, obesity and cardiovascular disease. The search for treatments to fight those complications has led researchers at Washington University School of Medicine in St. Louis to a drug that improves insulin sensitivity and lowers inflammation in people with HIV. The researchers believe long-term use of the drug, called sitagliptin, may help combat the metabolic problems that affect people with the virus.

RESEARCHERS AT WASHINGTON UNIVERSITY SCHOOL OF MEDICINE IN ST. LOUIS HAVE FOUND THAT A DIABETES DRUG APPEARS TO LOWER CARDIOVASCULAR RISK AND MORE EFFECTIVELY TREAT GLUCOSE PROBLEMS IN PEOPLE WITH HIV. JIM DRYDEN REPORTS�

ALTHOUGH HIV IS NO LONGER RAPIDLY FATAL, PEOPLE INFECTED WITH THE VIRUS WHO TAKE ANTIRETROVIRAL THERAPY HAVE AN ELEVATED RISK FOR DIABETES AND CARDIOVASCULAR PROBLEMS. WASHINGTON UNIVERSITY RESEARCHER KEVIN YARASHESKI SAYS RESEARCHERS HAVE TRIED LOTS OF WAYS TO CONTROL THOSE COMPLICATIONS IN PEOPLE WITH HIV, FROM STANDARD DIABETES DRUGS TO DIET TO EXERCISE, AND HE SAYS ALL OF THOSE APPROACHES HAVE WORKED TO SOME DEGREE�

(act) :28 o/c lipid levels

But they don�t normalize lipid levels and sugar levels
and insulin levels, and so we�re thinking there�s
something else going on, other than just sugar problems
and lipid problems and obesity problems. And what
everybody seems to agree in the field is that, well no,
there�s something in their immune systems, something
that�s causing an inflammatory response or reaction in
their body that�s making them a little more resistant
to, sort of standard therapies that you would give for
diabetes or high lipid levels.

BECAUSE PEOPLE WITH HIV ALSO TEND TO HAVE CHRONIC INFLAMMATION, YARASHESKI SAYS EFFECTIVE TREATMENTS NEED TO ADDRESS THAT, TOO.

(act) :13 o/c the trick (2nd ref)

We need to do something to turn down inflammation in these
individuals. We think that that�s the underlying problem
that�s causing all of these cardio-metabolic complications.
So again, just treating their sugar isn�t going to do the
trick. Just treating their lipids isn�t going to do the trick.

THE IDEA, HE SAYS, IS TO TRY TO �KILL TWO BIRDS WITH ONE STONE,� AS IT WERE. HIS TEAM TESTED THE DIABETES DRUG SITAGLIPTIN IN 36 PEOPLE WHO HAD HIV AND HAD BLOOD SUGAR PROFILES SUGGESTING THEY WERE PREDIABETIC.

(act) :22 o/c be done

We readjusted their sugars down to lower levels � that�s
a good thing for blood sugar management � but we also reduced
several markers of immune activation and inflammation that we
think is going to have even a greater beneficial effect on other
parameters like their hearts, like their bones and like their
livers, but those studies, those efficacy studies, still need
to be done.

AND YARASHESKI SAYS HE HOPES SUCH LONG-TERM STUDIES MAY BEGIN RELATIVELY SOON, BOTH FOR SITAGLIPTIN AND FOR RELATED DRUGS THAT MAY BE ABLE TO AFFECT BOTH METABOLISM AND INFLAMMATION.

(act) :16 o/c good match

For now in my mind, sitagliptin is one of the few in its
class that will have this beneficial effect, simply because
it�s not metabolized by the liver. It�s relatively safe. It�s
cleared in the urine. So for HIV, it�s a good match.

AND HE SAYS EFFECTIVE LONG-TERM THERAPIES FOR HIV-RELATED METABOLIC AND CARDIOVASCULAR PROBLEMS ARE NEEDED BECAUSE HIV ISN�T GOING ANYWHERE.

(act) :24 o/c complications now

And there will always be a need to do something to treat
not only these metabolic complications but also the immune
disregulation that goes on in an HIV-infected individual
that, again, we believe go hand-in-hand with the metabolic
complications. So it�s very hard to separate the two, but
if you have a drug that treat�s both, you�re one step
closer to a more effective treatment than what we have for
the complications now.

YARASHESKI�S TEAM REPORTED ITS FINDINGS IN THE JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM. I�M JIM DRYDEN…

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