I have a question about the possible use of leptin for insuline resistance.

I found the following article on Thebody.com dealing with Insulin resistance and HIV. http://www.thebody.com/sfaf/winter04/insulin.html

The article mentions... "Leptin also promotes normal insulin activity. Adiponectin improves insulin sensitivity as well, while resistin inhibits the action of insulin."

I am wondering, considering my situation, if Leptin may be useful based on what the article said? Would this something to try after the Actos but before the metformin? Or is the metformin a home run? (I have included my orgininal question with your response below).

Thank you for your time.

Graeme Moyle, M.D. Response:

There sounds like there is some 'swallowing the spider to catch the fly' going on here. Actos has not been well studied in HIV but its close relative Avandia causes a rise in triglycerides and cholesterol, an observation consistent across the 3 reported randomized studies. I suspect the Actos is the problem for your triglycerides. I would suggest a trial of stopping the Actos or, depending on how bad the insulin resistance is, replacing it with metformin, another insulin sensitiser which has been studied in HIV and which actually reduced triglycerides modestly and reduced abdominal fat

Original Question Greetings- Recently I have found that my lipid profile has been worsening. A year ago I was diagnosed as approaching "insulin resistant" so my Endocrinologist put me on Actos. Then my triglycerides shot up from 238 to 555 about the same time that I added Viramune to my 2 year running therapy of Trizivir. I can't help but suspect the Viramune, but my HIV doctor says that there is no evidence of that. Now my Endocrinologist wants to put me on Tricor for the triglycerides. I was told Viramune was to "backup" the Trizivir so I wonder if I'm taking the Actos and/or Tricor for a reaction from the HIV meds? Another question would be any negative interaction with all of these medications ? And is there any alternative mediations I should consider that would be better for my lipid profile? I had a buffalo hump removed 6 years ago and after that had a 1 year break from meds. I do have minor lipodystrophy signs on the limbs and a slight belly that is hard to work down. - Thank you very much.

Leptin, the 'satiety' factor produced by fat cells is not available as a medication. It has been studies in a small number of people with inherited forms of lipodystrophy and found to help a range of metabolic disturbances. However, it has not been tried in HIV and remains a long way from becoming a medication

kind regards

Graeme Moyle