Endothelial Dysfunction as a Risk Factor in HIV Study

INCLUSION CRITERIA Age 18 or older (The safety and effectiveness for some of the study medications have not been established in individuals younger than 18 years old). Documentation of HIV-1 infection by any licensed ELISA test kit and confirmed by a second method (e.g., Western Blot; or by HIV culture, plasma HIV RNA, or proviral HIV DNA). Taking a stable antiretroviral regimen, defined as having been on the same regimen for the 2 months preceding study entry, with no anticipated change in antiretroviral therapy for the four months following study enrollment. Willing to use appropriate contraception (barrier method) during the period of study. Able to provide written informed consent. Fasting insulin greater than or equal to 10 uU/ml. EXCLUSION CRITERIA Patients with any history of clinical coronary artery disease: Symptoms of angina pectoris (stable or unstable); History of myocardial infarction. Patients with clinical heart failure (left or right heart failure): Patients with New York Heart Association (NYHA) Class 3 and 4 cardiac status; Depressed left ventricular (LV) function on a prior study (less than 40% ejection fraction by radionuclide angiography or echocardiography). Patients with myocardial disease: dilated cardiomyopathy, hypertrophic cardiomyopathy, or restrictive cardiomyopathy as demonstrated by echocardiography. Patients with clinically significant valvular heart disease (based upon interpretation of a prior echo and/or the clinical judgment of the cardiologist co-investigator). Patients who smoke greater than or equal to 1 pack-per-day (PPD) (or patients unable to abstain from midnight the night prior to a blood flow study until the conclusion of the study). Patients unable to abstain from caffeine use (coffee, tea, or soda) from midnight the night prior to a blood flow study until the conclusion of the study. Patients with diabetes mellitus, on pharmacologic treatment. Systolic blood pressure greater than 160 or diastolic blood pressure greater than 100 at screening visit. Patients currently taking any drug from any of the three classes of medications being studied (If previously taken, last use must have been at least 2 months prior to screening): Patients with known hypersensitivity to any of the study medications; Patients taking medications with known interactions with the study medications. Patients currently taking any anti-hypertensive medications. Concomitant use of anticoagulant therapy (Due to drug interactions with gemfibrozil). Use of sildenafil within 12 hours of the vascular studies. Recent life-threatening opportunistic infections (within the past 6 months). Patients taking immunomodulating agents: Patients co-enrolled on protocols where IL2 is administered must not have received IL2 for the 2 months prior to enrollment and must be able to refrain from use of IL2 for the duration of the current study. Patients taking anabolic steroids, human growth hormone and/or testosterone for reasons other than replacement. Patients on replacement doses of testosterone will qualify if their free and total testosterone levels are within the normal range at screening. If free and total testosterone levels are within normal limit patients should refrain from testosterone injections for the two weeks preceding a FMD study. Patients taking trimethoprim and ketoconazole during the rosiglitazone arm of the study. Pregnancy or Breastfeeding (Some of the study drugs are contraindicated during pregnancy and lactation). Baseline elevations in ALT, AST (greater than 2x ULN) or CPK (greater than 500 U/L). History of liver disease or heavy alcohol ingestion (4 or more drinks a day). History of severe renal dysfunction (serum creatinine at baseline of greater than 1.5). Anemia (hemoglobin less than 10 mg/dl). History of cholelithiasis. Refusal to follow Clinical Center policy on partner notification. Inability to provide informed consent.