Metformin use does not significantly affect immune reconstitution among patients with HIV infection and comorbid type 2 diabetes, according to results of a study published in Open Forum Infectious Diseases.
Prior research suggests metformin is associated with immunoregulatory effects among HIV populations. However, there is little long-term data about the effect of metformin on CD4+ T-cell count or CD4/CD8 ratio.
Researchers conducted a retrospective study to examine the relationship between metformin treatment and immune reconstitution in patients with HIV infection. Study patients (N=1332) included those born between 1961 and 1981 receiving care at the Karolinska University Hospital in Sweden. Patients with comorbid type 2 diabetes who initiated metformin following at least 2 years of exposure to effective antiretroviral therapy (ART) were matched 1:1 against those with HIV alone (controls). The primary outcomes were the change in CD4+ count and CD4/CD8 ratio in the 1.5 to 3.5 years after metformin initiation relative to the 2 years prior to initiation.
Among patients in the metformin (n=43) and control (n=43) cohorts, the median ages were 48 (IQR, 44-51) and 47 (IQR, 53-52) years, 67% and 67% were men, the median BMI values were 28 (IQR, 27-32) and 26 (IQR, 24-30) kg/m2, 65% and 56% were born in Sub-Saharan Africa, and the median time since ART initiation was 11 (IQR, 7-14) and 11 (IQR, 8-15) years, respectively.
Patients with HIV and comorbid type 2 diabetes initiated metformin at a median dose of 1700 (IQR, 1000-2000) mg daily.
At baseline, 26% of patients in both cohorts showed CD4+ counts below 500 cells/µL, and 70% showed a CD4/CD8 ratio of less than 1. Between-group analyses indicated no significant differences in the trajectory of CD4+ T-cell count (P =.50) or CD4/CD8 ratio (P =.39) in the 2 years before metformin initiation.
In the 1.5 to 3.5 years after metformin initiation, 60% and 81% of patients with comorbid type 2 diabetes experienced increased CD4+ T-cell counts and increased CD4/CD8 ratio, respectively. The overall rate of patients in the control cohort who exhibited increased levels of these measurements over the same period was higher for CD4+ count (67%) but lower for CD4/CD8 ratio (77%). However, the median change in CD4+ count was not significantly different between metformin recipients and control patients (35 vs 48 cells/µL; P =.96), with similar findings observed for the change in CD4/CD8 ratio (0.10 vs 0.08; P =.18).
Further analysis showed no significant trends among individuals with low CD4+ count and CD4/CD8 ratio at baseline. The researchers also noted no significant trends observed when the daily dose of metformin was adjusted for dolutegravir exposure.
Study limitations include the small sample size and long-term exposure to effective ART among patients in both cohorts.
According to the researchers, “[T]his study represents the longest follow-up on CD4 T cell count and CD4/CD8 ratio in PLWH [people living with HIV] treated with metformin.”
Disclosure: This research was supported by the Gilead Nordic Fellowship Program. Please see the original reference for a full list of disclosures.
By Jessica Nye, PhD
References:
Bäckdahl T, Hedberg P, Vesterbacka J, Carlander C, Sönnerborg A, Nowak P. Metformin treatment and immune reconstitution in people living with HIV and type 2 diabetes: a matched retrospective study. Open Forum Infect Dis. Published online February 24, 2025. doi:10.1093/ofid/ofaf110
Source : Infectious Disease Advisor
Related HIV and Co-Infections News
Get involved
Are you living with HIV/AIDS? Are you part of a community affected by HIV/AIDS and co-infections? Do you work or volunteer in the field? Are you motivated by our cause and interested to support our work?
Subscribe
Stay in the loop and get all the important EATG updates in your inbox with the EATG newsletter. The HIV & co-infections bulletin is your source of handpicked news from the field arriving regularly to your inbox.