CONTEXT: People infected with HIV have a higher risk for developing insulin resistance, diabetes, and cardiovascular disease than the general population. Dipeptidyl peptidase IV (DPP4) inhibitors are glucose-lowering medications with pleiotropic actions that may particularly benefit people with HIV, but the immune and virological safety of DPP4 inhibition in HIV is unknown. OBJECTIVE: DPP4 inhibition will not reduce CD4+ T lymphocyte number or increase HIV viremia in HIV-positive adults. DESIGN: This was a randomized, placebo-controlled, double-blind safety trial of sitagliptin in HIV-positive adults. SETTING: The study was conducted at an academic medical center. PARTICIPANTS: Twenty nondiabetic HIV-positive men and women (9.8 ± 5.5 years of known HIV) taking antiretroviral therapy and with stable immune (625 ± 134 CD4+ T cells per microliter) and virological (<48 copies HIV RNA per milliliter) status. INTERVENTION: The intervention included sitagliptin (100 mg/d) vs matching placebo for up to 24 weeks. MAIN OUTCOME MEASURES: CD4+ T cell number and plasma HIV RNA were measured every 4 weeks; fasting serum regulated upon activation normal T-cell expressed and secreted (RANTES), stromal derived factor (SDF)-1α, Soluble TNF receptor II, and oral glucose tolerance were measured at baseline, week 8, and the end of study. ANOVA was used for between-group comparisons; P < .05 was considered significant. RESULTS: Compared with placebo, sitagliptin did not reduce CD4+ T cell count, plasma HIV RNA remained less than 48 copies/mL, RANTES and soluble TNF receptor II concentrations did not increase. SDF1α concentrations declined (P < .0002) in the sitagliptin group. The oral glucose tolerance levels improved in the sitagliptin group at week 8. CONCLUSIONS: Despite lowering SDF1α levels, sitagliptin did not adversely affect immune or virological status, or increase immune activation, but did improve glycemia in healthy, nondiabetic HIV-positive adults. These safety data allow future efficacy studies of sitagliptin in HIV-positive people with cardiometabolic complications.
RCT Entities:
CONTEXT: People infected with HIV have a higher risk for developing insulin resistance, diabetes, and cardiovascular disease than the general population. Dipeptidyl peptidase IV (DPP4) inhibitors are glucose-lowering medications with pleiotropic actions that may particularly benefit people with HIV, but the immune and virological safety of DPP4 inhibition in HIV is unknown. OBJECTIVE:DPP4 inhibition will not reduce CD4+ T lymphocyte number or increase HIV viremia in HIV-positive adults. DESIGN: This was a randomized, placebo-controlled, double-blind safety trial of sitagliptin in HIV-positive adults. SETTING: The study was conducted at an academic medical center. PARTICIPANTS: Twenty nondiabetic HIV-positivemen and women (9.8 ± 5.5 years of known HIV) taking antiretroviral therapy and with stable immune (625 ± 134 CD4+ T cells per microliter) and virological (<48 copies HIV RNA per milliliter) status. INTERVENTION: The intervention included sitagliptin (100 mg/d) vs matching placebo for up to 24 weeks. MAIN OUTCOME MEASURES: CD4+ T cell number and plasma HIV RNA were measured every 4 weeks; fasting serum regulated upon activation normal T-cell expressed and secreted (RANTES), stromal derived factor (SDF)-1α, Soluble TNF receptor II, and oral glucose tolerance were measured at baseline, week 8, and the end of study. ANOVA was used for between-group comparisons; P < .05 was considered significant. RESULTS: Compared with placebo, sitagliptin did not reduce CD4+ T cell count, plasma HIV RNA remained less than 48 copies/mL, RANTES and soluble TNF receptor II concentrations did not increase. SDF1α concentrations declined (P < .0002) in the sitagliptin group. The oral glucose tolerance levels improved in the sitagliptin group at week 8. CONCLUSIONS: Despite lowering SDF1α levels, sitagliptin did not adversely affect immune or virological status, or increase immune activation, but did improve glycemia in healthy, nondiabetic HIV-positive adults. These safety data allow future efficacy studies of sitagliptin in HIV-positive people with cardiometabolic complications.
Authors: G Scarlatti; E Tresoldi; A Björndal; R Fredriksson; C Colognesi; H K Deng; M S Malnati; A Plebani; A G Siccardi; D R Littman; E M Fenyö; P Lusso Journal: Nat Med Date: 1997-11 Impact factor: 53.440
Authors: Dominic N Reeds; W Todd Cade; Bruce W Patterson; William G Powderly; Samuel Klein; Kevin E Yarasheski Journal: Diabetes Date: 2006-10 Impact factor: 9.461
Authors: Michael J Carper; W Todd Cade; Margaret Cam; Sheng Zhang; Anath Shalev; Kevin E Yarasheski; Sasanka Ramanadham Journal: Am J Physiol Endocrinol Metab Date: 2008-01-02 Impact factor: 4.310
Authors: Stephane De Wit; Caroline A Sabin; Rainer Weber; Signe Westring Worm; Peter Reiss; Charles Cazanave; Wafaa El-Sadr; Antonella d'Arminio Monforte; Eric Fontas; Matthew G Law; Nina Friis-Møller; Andrew Phillips Journal: Diabetes Care Date: 2008-02-11 Impact factor: 17.152
Authors: Michael P Dubé; Ellen S Chan; Jordan E Lake; Brett Williams; Jennifer Kinslow; Alan Landay; Robert W Coombs; Michelle Floris-Moore; Heather J Ribaudo; Kevin E Yarasheski Journal: Clin Infect Dis Date: 2019-09-13 Impact factor: 20.999