Hello! Thank you for being there to answer tough questions.

In a recent reply you mentioned glitazone as something being looked at to replace subcutaneous fat. Would this be dangerous to take if you were not already diabetic or established as having insulin resistance? (Is it being used for HIV in non-standard doses?) And how does one medically test for insulin resistance anyway?

- Thanks, Chris

Glitazones (particularly pioglitazone and rosiglitazone) are under investigation in a few parts of the world. As usual, particularly in HIV infection, clinical practice often precedes research. So, in the U.S. this is mostly being tried on a "give it a shot" basis. Previous studies on rosiglitazone suggested potential for dose ranges between 4-8 mg/day. There are potential side effects as with any drug and there is always a risk vs. benefit decision to make.

Fasting insulin does not always show insulin resistance. To test for insulin resistance, you can have a glucose tolerance test and look at insulin levels from baseline, hour 1, and hour 2 to determine a problem.

Hopefully we will get some answers on the use of antidiabetic medications to improve the adverse effects of insulin resistance seen in HIV infection.