Repurposing Metformin in Nondiabetic People With HIV: Influence on Weight and Gut Microbiota
Open accessAbstract
BACKGROUND: People with HIV (PWH) taking antiretroviral therapy (ART) may experience weight gain, dyslipidemia, increased risk of non-AIDS comorbidities, and long-term alteration of the gut microbiota. Both low CD4/CD8 ratio and chronic inflammation have been associated with changes in the gut microbiota of PWH. The antidiabetic drug metformin has been shown to improve gut microbiota composition while decreasing weight and inflammation in diabetes and polycystic ovary syndrome. Nevertheless, it remains unknown whether metformin may benefit PWH receiving ART, especially those with a low CD4/CD8 ratio. METHODS: In the Lilac pilot trial, we recruited 23 nondiabetic PWH receiving ART for more than 2 years with a low CD4/CD8 ratio (<0.7). Blood and stool samples were collected during study visits at baseline, after a 12-week metformin treatment, and 12 weeks after discontinuation. Microbiota composition was analyzed by 16S rDNA gene sequencing, and markers of inflammation were assessed in plasma. RESULTS: Metformin decreased weight in PWH, and weight loss was inversely correlated with plasma levels of the satiety factor GDF-15. Furthermore, metformin changed the gut microbiota composition by increasing the abundance of anti-inflammatory bacteria such as butyrate-producing species and the protective CONCLUSIONS: Our study provides the first evidence that a 12-week metformin treatment decreased weight and favored anti-inflammatory bacteria abundance in the microbiota of nondiabetic ART-treated PWH. Larger randomized placebo-controlled clinical trials with longer metformin treatment will be needed to further investigate the role of metformin in reducing inflammation and the risk of non-AIDS comorbidities in ART-treated PWH.
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There is a direct cause-effect relationship between GDF-15 plasma level change and weight change during and after metformin discontinuation.
“We showed that metformin, independent of its glucose-lowering effect, increased plasma levels of GDF-15 and decreased weight, and its effects vanished upon discontinuation, establishing a direct cause-effect relationship between GDF-15 plasma level change and weight change during and after metformin discontinuation (25).”
From GDF-15 as a Weight Watcher for Diabetic and Non-Diabetic People Treated With Metformin (2020) · cites this paper as [25]
The effects of metformin on plasma GDF-15 and weight vanished upon discontinuation.
“We showed that metformin, independent of its glucose-lowering effect, increased plasma levels of GDF-15 and decreased weight, and its effects vanished upon discontinuation, establishing a direct cause-effect relationship between GDF-15 plasma level change and weight change during and after metformin discontinuation (25).”
From GDF-15 as a Weight Watcher for Diabetic and Non-Diabetic People Treated With Metformin (2020) · cites this paper as [25]
GDF-15 is a key mediator of metformin-induced weight loss.
“Recently, the growth differentiation factor 15 (GDF-15), a member of the transforming growth factor beta superfamily, has been identified as a key mediator of metformin-induced weight loss.”
From GDF-15 as a Weight Watcher for Diabetic and Non-Diabetic People Treated With Metformin (2020) · cites this paper as [25]
In non-diabetic, non-obese people living with HIV receiving effective antiretroviral therapy, metformin increased plasma GDF-15 and decreased weight independent of its glucose-lowering effect.
“We showed that metformin, independent of its glucose-lowering effect, increased plasma levels of GDF-15 and decreased weight, and its effects vanished upon discontinuation, establishing a direct cause-effect relationship between GDF-15 plasma level change and weight change during and after metformin discontinuation (25).”
From GDF-15 as a Weight Watcher for Diabetic and Non-Diabetic People Treated With Metformin (2020) · cites this paper as [25]
A 12-week metformin treatment decreased the weight of non-diabetic people living with HIV under antiretroviral therapy.
“Finally, a 12-week metformin treatment decreased the weight of non-diabetic people living with HIV under antiretroviral therapy (25).”
From GDF-15 as a Weight Watcher for Diabetic and Non-Diabetic People Treated With Metformin (2020) · cites this paper as [25]
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The effect of dolutegravir on the pharmacokinetics of metformin in healthy subjects
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Risk of Colorectal Cancer and Associated Mortality in HIV: A Systematic Review and Meta-Analysis
O’Neill, T. J., Nguemo, J., Tynan, A., Burchell, A. N., & Antoniou, T. (2017) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001433 · Cited by 34 · see citing works
Shikuma, C. M., Chew, G. M., Kohorn, L. B., Souza, S. A., Chow, D. C., SahBandar, I. N., Park, E. Y., Hanks, N., Gangcuangco, L. M. A., Gerschenson, M., et al. (2019) · AIDS Research and Human Retroviruses · doi:10.1089/aid.2019.0078 · Cited by 33 · see citing works
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The evaluation of risk-benefit ratio for gut tissue sampling in HIV cure research
Mehraj, V., Ghali, P., Ramendra, R., Costiniuk, C. T., Lebouché, B., Ponte, R., Reinhard, R. J., Sousa, J., Chomont, N., Cohen, É. A., et al. (2017) · Journal of Virus Eradication · doi:10.1016/s2055-6640(20)30316-2 · Cited by 16 · see citing works
Flagged first, then by citations
1 of the 83 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [27]Hill A, McCann KM, Pilkington V, et al. Risks of metabolic syndrome, diabetes and cardiovascular disease in advance trial [a bstract 00081 ]. Paper presented at: Conference on Retroviruses and Opportunistic Infection; March 8–11, 2020; Boston, MA.
Cited by
Sorted by citations
Sharing CD4+ T Cell Loss: When COVID-19 and HIV Collide on Immune System
Peng, X., Ouyang, J., Isnard, S., Lin, J. C.-Y., Fombuena, B., Zhu, B., & Routy, J. (2020) · Frontiers in Immunology · doi:10.3389/fimmu.2020.596631 · Cited by 122 · see citing works
Planas, D., Pagliuzza, A., Ponte, R., Fert, A., Marchand, L. R., Massanella, M., Gosselin, A., Mehraj, V., Dupuy, F. P., Isnard, S., et al. (2021) · EBioMedicine · doi:10.1016/j.ebiom.2021.103270 · Cited by 68 · see citing works
GDF15/GFRAL Pathway as a Metabolic Signature for Cachexia in Patients with Cancer
Ahmed, D. S., Isnard, S., Lin, J. C.-Y., Routy, B., & Routy, J. (2020) · Journal of Cancer · doi:10.7150/jca.50376 · Cited by 66 · see citing works
Metformin and Its Immune-Mediated Effects in Various Diseases
Nojima, I., & Wada, J. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24010755 · Cited by 54 · see citing works
Mezhibovsky, E., Knowles, K. A., He, Q., Sui, K., Tveter, K. M., Duran, R. M., & Roopchand, D. E. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.675267 · Cited by 46 · see citing works
Coping With Stress: The Mitokine GDF-15 as a Biomarker of COVID-19 Severity
Ahmed, D. S., Isnard, S., Berini, C. A., Lin, J. C.-Y., Routy, J., & Royston, L. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.820350 · Cited by 44 · see citing works
Frailty and HIV: Moving from Characterization to Intervention
Erlandson, K. M., & Piggott, D. A. (2021) · Current HIV/AIDS Reports · doi:10.1007/s11904-021-00554-1 · Cited by 41 · see citing works
GDF-15 as a Weight Watcher for Diabetic and Non-Diabetic People Treated With Metformin
Ouyang, J., Isnard, S., Lin, J., Fombuena, B., Peng, X., Chen, Y., & Routy, J.-P. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.581839 · Cited by 39 · see citing works
Gut Leakage of Fungal‐Related Products: Turning Up the Heat for HIV Infection
Isnard, S., Lin, J. C.-Y., Bu, S., Fombuena, B., Royston, L., & Routy, J. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.656414 · Cited by 35 · see citing works
Probing the Interface of HIV and Inflammaging
Sieg, S. F., Shive, C. L., Panigrahi, S., & Freeman, M. L. (2021) · Current HIV/AIDS Reports · doi:10.1007/s11904-021-00547-0 · Cited by 33 · see citing works
Jamal, R., Messaoudene, M., de Figuieredo, M., & Routy, B. (2023) · Seminars in Immunology · doi:10.1016/j.smim.2023.101754 · Cited by 31 · see citing works
Self-citationXia, Y. L., Zhang, X., Jiang, M., Zhang, H., Wang, Y., Zhang, Y., Seviour, R. J., & Kong, Y. (2021) · PLoS ONE · doi:10.1371/journal.pone.0260757 · Cited by 30 · see citing works
HIV and comorbidities – the importance of gut inflammation and the kynurenine pathway
MacCann, R., LANDAY, A. L., & Mallon, P. W. G. (2022) · Current Opinion in HIV and AIDS · doi:10.1097/coh.0000000000000782 · Cited by 25 · see citing works
Hanna, A., Abbas, H., Yassine, F., Albush, A., & Bilen, M. (2025) · Frontiers in Microbiology · doi:10.3389/fmicb.2025.1549499 · Cited by 23 · see citing works
Cao, W., Liu, X., Han, Y., Song, X., Lu, L., Li, X., Lin, L., Sun, L., Liu, A., Zhao, H., et al. (2023) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2023.100724 · Cited by 22 · see citing works
Cytomegalovirus as an Uninvited Guest in the Response to Vaccines in People Living with HIV
Royston, L., Isnard, S., Lin, J. C.-Y., & Routy, J. (2021) · Viruses · doi:10.3390/v13071266 · Cited by 19 · see citing works
Ha, R., Keynan, Y., & Rueda, Z. V. (2022) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2022.980868 · Cited by 18 · see citing works
Adipose Tissue Dysfunction and Energy Balance Paradigms in People Living With HIV
Ramirez, C. E., Agarwal, N., Cox, A. R., Hartig, S. M., Lake, J. E., & Balasubramanyam, A. (2023) · Endocrine Reviews · doi:10.1210/endrev/bnad028 · Cited by 19 · see citing works
Alhusayen, R. O., Dienes, S., Lam, M., Alavi, A., Alikhan, A., Aleshin, M. A., Bahashwan, E., Daveluy, S. D., Goldfarb, N. I., Garg, A., et al. (2024) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2024.11.071 · Cited by 16 · see citing works
Yan, J., Ouyang, J., Isnard, S., Zhou, X., Harypursat, V., Routy, J., & Chen, Y. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.741658 · Cited by 15 · see citing works
Association between gut microbiota and prediabetes in people living with HIV
Jayanama, K., Phuphuakrat, A., Pongchaikul, P., Prombutara, P., Nimitphong, H., Reutrakul, S., & D, S. S. M. (2022) · Current Research in Microbial Sciences · doi:10.1016/j.crmicr.2022.100143 · Cited by 14 · see citing works
Fert, A., Richard, J., Marchand, L. R., Planas, D., Routy, J., Chomont, N., Finzi, A., & Ancuța, P. (2024) · iScience · doi:10.1016/j.isci.2024.110670 · Cited by 14 · see citing works
Elevated CD4+ T-cell glucose metabolism in HIV+ women with diabetes mellitus
Butterfield, T. R., Hanna, D. B., Kaplan, R. C., Xue, X., Kizer, J. R., Durkin, H. G., Kassaye, S. G., Nowicki, M., Tien, P. C., Topper, E. T., et al. (2022) · AIDS · doi:10.1097/qad.0000000000003272 · Cited by 10 · see citing works
Rezaei, S., Timani, K. A., & He, J. J. (2023) · Aging and Disease · doi:10.14336/ad.2023.0705 · Cited by 10 · see citing works
Ding, X., Meng, P., Ma, X., Yue, J.-Y., Li, L., & Xu, L. (2024) · Frontiers in Microbiomes · doi:10.3389/frmbi.2024.1276015 · Cited by 9 · see citing works
Zaongo, S. D., & Chen, Y. (2023) · Chinese Medical Journal · doi:10.1097/cm9.0000000000002493 · Cited by 8 · see citing works
Isnard, S., Fombuena, B., Ouyang, J., Royston, L., Lin, J. C.-Y., Bu, S., Sheehan, N. L., Lakatos, P. L., Bessissow, T., Chomont, N., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-053081 · Cited by 8 · see citing works
Isnard, S., Royston, L., Scott, S. C., Mabanga, T., Lin, J. C.-Y., Fombuena, B., Bu, S., Berini, C. A., Goldberg, M. S., Finkelman, M., et al. (2023) · AIDS Research and Therapy · doi:10.1186/s12981-023-00525-z · Cited by 7 · see citing works
HIV and the gut microbiome: future research hotspots and trends
Wu, Z., Xie, Z.-P., Cui, X., Sun, X., Zhao, F., Wang, N., Li, Y., Wang, H., Zhang, L., Shen, J., et al. (2025) · Frontiers in Microbiology · doi:10.3389/fmicb.2025.1466419 · Cited by 6 · see citing works
Krismawati, H., Muchtar, S. V., Rahardjani, M., Oktaviani, M., ., S., Imbiri, N., Hasvitasari, D. E., Fajrianti, D. R., Tarino, N., Wulandari, F., et al. (2023) · Wellcome Open Research · doi:10.12688/wellcomeopenres.19455.1 · Cited by 6 · see citing works
Krismawati, H., Muchtar, S. V., Rahardjani, M., Utami, N. N., Oktaviani, M., Puspatriani, K., ., S., Imbiri, N., Hasvitasari, D. E., Fajrianti, D. R., et al. (2024) · Wellcome Open Research · doi:10.12688/wellcomeopenres.19455.2 · Cited by 5 · see citing works
Royston, L., Isnard, S., Berini, C. A., Bu, S., Lakatos, P. L., Bessissow, T., Chomont, N., Klein, M. B., Lebouché, B., de Pokomandy, A., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-067640 · Cited by 5 · see citing works
Castillo‐Rozas, G., López, M. N., Soto‐Rifo, R., Vidal, R. M., & Cortés, C. P. (2023) · AIDS · doi:10.1097/qad.0000000000003450 · Cited by 5 · see citing works
Moreno-López, R., Lazaro-Martin, B., Díez, C., Navarro‐Gómez, M. L., & Tarancón‐Díez, L. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1734023 · Cited by 4 · see citing works
Righetti, R., Cinque, F., Lebouché, B., Ballesteros, L. R., Routy, J., Klein, M. B., Szabo, J., Cox, J., Falutz, J., Haraoui, L., et al. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26178165 · Cited by 4 · see citing works
Isnard, S., Royston, L., Berini, C. A., Mabanga, T., Al‐Abdulmalek, A., Aiyana, O., Sun, L., Far, M. E., Pagliuzza, A., Planas, D., et al. (2026) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiag202 · Cited by 3 · see citing works
Metformin, Microbiota and Health
Paz, G. S., & Fernandes, J. (2022) · Journal of Exploratory Research in Pharmacology · doi:10.14218/jerp.2022.00032 · Cited by 3 · see citing works
Interventions for Type 2 Diabetes reduction among older people living with HIV in Harare
Mhlanga, N. L., & Netangaheni, R. T. (2024) · South African Family Practice · doi:10.4102/safp.v66i1.5827 · Cited by 3 · see citing works
López‐López, A., Alonso-Domínguez, J., Martínez-Barros, I., Pérez‐González, A., Ocampo, A., Morano, L. E., Cruz, B. C., de Castro, N. M. L., Pardo, O. B., Pérez‐Olmeda, M., et al. (2026) · Infectious Diseases and Therapy · doi:10.1007/s40121-026-01302-x · Cited by 2 · see citing works
An army marches on its stomach: immunometabolic dysregulation in persons with HIV
Routy, J., & Isnard, S. (2023) · AIDS · doi:10.1097/qad.0000000000003558 · Cited by 2 · see citing works
HIV and Aging in the Era of ART and COVID-19: Symposium Overview
Montano, M. A., LANDAY, A. L., Perkins, M. M., Holstad, M. M., Pallikkuth, S., Pahwa, S. G., & Symposium, H. A. A. I. T. E. O. A. A. C.-1. I.-C. (2022) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000002837 · Cited by 1 · see citing works
A Canadian Survey of Research on HIV-1 Latency—Where Are We Now and Where Are We Heading?
Abdalla, A. L., Guajardo-Contreras, G., & Mouland, A. J. (2024) · Viruses · doi:10.3390/v16020229 · Cited by 1 · see citing works
Flower power: Locking HIV in the gut with French lilac
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Metformin for endothelial dysfunction in non-diabetic disorders: a scoping review
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Marcelo, C., Esteban-Cantos, A., Jurado, F., Montejano, R., Gutiérrez-García, L., Grela, A. D. G., Martínez-Martín, P., Vidal, A. D., Buckley, R. D. M., López, C. M. O., et al. (2026) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofag489
- Authors
- Isnard, S., Lin, J., Fombuena, B., Ouyang, J., Varin, T. V., Richard, C., Marette, A., Ramendra, R., Planas, D., Raymond Marchand, L., Messaoudene, M., Van der Ley, C. P., Kema, I. P., Sohail Ahmed, D., Zhang, Y., Finkelman, M., Routy, B., Angel, J., Ancuta, P., & Routy, J.-P.
- Affiliations
- McGill University Health Centre (CA)
- Université Laval (CA)
- Centre Hospitalier de l’Université de Montréal (CA)
- Institut universitaire de cardiologie et de pneumologie de Québec (CA)
- University of Toronto (CA)
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
- University Medical Center Groningen (NL)
- Infectious Diseases and Immunity in Global Health Program, Research Institute, McGill University Health Centre, Montreal, Québec, Canada
- Associates of Cape Cod Inc., Falmouth, Massachusetts, USA
- University of Ottawa (CA)
- Corresponding author
- Routy, Jean-Pierre
- ORCID
- Venue
- Open Forum Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-09-01
- Volume
- 7
- Issue
- 9
- Pages
- ofaa338-ofaa338
- ISSN
- 2328-8957 (ISSN-L)
- PMC
- PMC7489545
- OpenAlex
- W3048183771
- Cited by
- 51
- References
- 83
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 8 · 2023: 11 · 2022: 8 · 2021: 10 · 2020: 3
- FWCI
- 7.70
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Open Forum Infectious Diseases (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by-nc)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc)
- Funders
- Canadian Institutes of Health Research (CIHR CTN PT07, MOP 103230, PTJ 166049, HB2-164064)
- Fond de Recherche Quebec Sante fellowship
- Topics
- Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
- Keywords
- metformin, HIV, antiretroviral therapy, weight gain, gut microbiota, CD4/CD8 ratio, chronic inflammation, GDF15, butyrate-producing bacteria, non-AIDS comorbidities, drug repurposing
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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