Sitagliptin gives insulin a boost so that more sugar can be processed out of the bloodstream. The drug appears to be safe for use by HIV-positive people at risk for diabetes.
People with HIV have an elevated risk of heart attacks, diabetes and insulin problems. To compound matters, there are not many drug options to prevent those secondary problems because of concerns that they will weaken the immune system.
But a new study by researchers at Washington University School of Medicine in St. Louis has shown that a diabetes drug appears to be safe in HIV-infected patients and does not adversely affect their immune systems.
The research appeared in the February issue of the Journal of Clinical Endocrinology & Metabolism.
“The drug we studied, sitagliptin, was developed for type 2 diabetes and has been on the market since 2006, but it hadn’t been tested for safety in HIV,” says senior investigator Kevin E. Yarasheski, PhD. “In our small study, the drug seems to be safe. Now, it needs to be tested in people who are HIV positive and have metabolic problems to see whether it can reduce their likelihood of developing diabetes.”
Most people with HIV are treated with drug “cocktails” that keep levels of the virus low. The use of these drug combinations means that HIV is no longer a death sentence for most patients and can be managed as a chronic condition.
However, living with HIV and the required drug therapy increases the risk for cholesterol abnormalities and diabetes, and those problems elevate the risk for heart disease. The result is that patients taking therapy for HIV infection are almost twice as likely as the rest of the population to develop diabetes or have a heart attack, often at a young age, highlighting the need for safe and more effective treatments.
The study involved 20 HIV-positive male and female volunteers already taking HIV-drug cocktails to stabilize their immune systems. In addition, the participants either received sitagliptin or an inactive placebo for up to six months. Throughout the study, researchers assessed immune function by a standard measure: counting levels of a key immune cell called CD4+ T-cell.
“Everyone came into the study with a viral load below the level that could be detected, and they all had healthy CD4 counts,” Yarasheski explains. “Their viral loads remained undetectable throughout the study, and their CD4 counts did not decline.”