Eplerenone in HIV Associated Abdominal Fat Accumulation

Inclusion Criteria: 1. Increased waist circumference based on NCEP guidelines (\>102cm in men and \>88cm in women) and impaired glucose tolerance (either IFG \> 100 mg/dL but \< 126 mg/dL or 2hr glucose \> 140 mg/dl but \< 200 mg/dL, or fasting insulin \>12 uIU/mL) 2. HIV positive for 5y and on a stable ART regimen for at least 12 months 3. Age ≥ 30 and ≤ 65 years of age Exclusion Criteria: 1. ACE Inhibitor, ARB, verapamil, or spironolactone 2. Potassium supplementation 3. Estimated GFR\<60, creatinine \> 1.5 mg/dL 4. Serum K \> 5.5 mEq/L, ALT \> 2.5 times the upper limit of normal, Hgb \< 11g/dL 5. Uncontrolled hypertension (SBP ≥ 160 or DBP ≥ 100) 6. Current or prior steroid use within past 6 months 7. Known history of diabetes mellitus or current use of anti-diabetic medications 8. Concomitant use of full dose ritonavir, nelfinavir, clarithromycin and other strong inhibitors of CYP34A 9. Use of St. John's Wart (CYP3A4 inducer) 10. Pregnant or actively seeking pregnancy, breastfeeding 11. For women: Pregnant or actively seeking pregnancy, breastfeeding, failure to use an acceptable non-hormonal form of birth control, including abstinence, barrier contraceptives, or non-hormonal IUD. 12. Estrogen or progestational derivative use within 3 months 13. Testosterone use for non-physiologic purposes, or physiologic testosterone replacement for \< 3 months. 14. Current growth hormone or growth hormone releasing hormone use 15. Current viral, bacterial or other infections (excluding HIV) 16. Current active substance abuse 17. Patients with a significant history of cardiovascular disease, including prior MI or stroke