Cited by 51HIV-related health complications and treatmentsGut microbiota and healthHIV/AIDS drug development and treatment

Repurposing Metformin in Nondiabetic People With HIV: Influence on Weight and Gut Microbiota

Open access
Isnard, Stéphane, Lin, John, Fombuena, Brandon, Ouyang, Jing, Varin, Thibault V, Richard, Corentin, Marette, André, Ramendra, Rayoun +12 more·2020·Open Forum Infectious Diseases

Abstract

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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Crossref · 10.1093/ofid/ofaa338

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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).”
  • 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).”
  • 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.”
  • 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).”
  • 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).”

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  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.

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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
Venue
Open Forum Infectious Diseases
Published
2020-09-01
Volume
7
Issue
9
Pages
ofaa338-ofaa338
ISSN
2328-8957 (ISSN-L)
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
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

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