TAILoR Study: telmisartan to reduce risk of insulin resistance: potential role for lipodystrophy
Simon Collins, HIV i-Base
The UK TAILOR study plans to enrol almost 400 HIV positive people who are already on stable HIV treatment. 
Participants will be randomised to use different doses of telmisartan (20 mg, 40 mg or 80 mg) to see whether this reduces the risks of developing diabetes or heart disease.
The 48 week study involves taking one (small) pill daily. People taking the 80 mg dose may use a formulation that involves either one or two daily pills.
Of interest, two small studies have looked at whether telmisartan might have a benefit against HIV-related lipodystrophy, especially for central fat accumulation.
One looked at whether telmisartan (40 mg daily) could help reduce central fat accumulation (visceral fat – a symptom of lipodystrophy) in 35 people. There was a range of responses after 24 weeks. No benefit was reported for visceral fat but reductions were seen for total body fat and subcutaneous fat. 
Another small study (n=18) used a higher dose of telmisartan (80 mg daily) for HIV positive people who already had high blood pressure. As well as reducing blood pressure, there were benefits in insulin sensitivity and blood lipids (triglycerides and cholesterol). 
This TAILOR study has 11 UK sites:
- Royal Liverpool Hospital, Merseyside
- Royal Free Hospital, London
- Guys and St Thomas’ Hospital, London
- Kings College Hospital, London
- Royal Bournemouth Hospital, Dorset
- Western General Hospital, Edinburgh
- St. James’ Hospital, Leeds
- City of Coventry Health Centre, Coventry
- Brighton and Sussex University Hospitals
- James Cook University Hospital, Middlesbrough
- York Clinic, York
By April 2014, over 110 people have already been enrolled.
- Tailor study website
- Lake JE et al. A pilot study of telmisartan for visceral adiposity in HIV infection: the metabolic abnormalities, telmisartan, and HIV infection (MATH) trial. PLoS One. 2013;8(3):e58135. doi: 10.1371/journal.pone.0058135. Epub 2013 Mar 14.
- Vecchiet J et al. Antihypertensive and metabolic effects of telmisartan in hypertensive HIV-positive patients. Antivir Ther. 2011;16(5):639-45. doi: 10.3851/IMP1809.