The results of this study reported at the 13th CROI (Denver, Feb 5-8, 2006) found worrisome effects of metformin, reported a research group from Tufts (Abby Shevitz, MD). The study authors reported metformin did not significantly improve glucose or insulin AUC at week 24. Metformin group did not experience significant change in fasting glucose or insulin at week 24. Of note, the metforim group experienced significant reduction in BMI at week 24 from a mean of 27.3 to 25.7 kg/m2). Authors reported metformin did not significantly improve fat redistribution or dyslipidemia in HIV+ persons with central adiposity (fat belly) and fasting insulin <18 uU/mL. If you look at table below you will see metformin group (n=17) experienced -10.1% reduction in VAT vs -3.2 for placebo, but p-value = 0.58. Of note, metformin was associated with unexpected trend in reduction in appendicular fat mass (limb fat decreased), suggesting risk of worsening limb fat or lipoatrophy. The authors concluded that the study data suggests that metformin should be used with caution in HIV lipodystrophy; reserved for persons with marked insulin resistance and adequate subcutaneous fat.