Growth Hormone Reduces Fat In HIV Patients With Abdominal Obesity

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Main Category: HIV / AIDS
Also Included In: Infectious Diseases / Bacteria / Viruses;  Endocrinology;  Obesity / Weight Loss / Fitness
Article Date: 04 Aug 2008 - 0:00 PDT

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According to an article published on August 6 in a special HIV/AIDS issue of JAMA, a low-dose hormone treatment for human immunodeficiency virus (HIV)-infected patients who have treatment-related abdominal obesity and growth hormone deficiency resulted in gains in fat and blood pressure measurements. However, Steven Grinspoon, M.D. (Massachusetts General Hospital, Boston) and colleagues also found that the treatment worsened glucose levels.

HIV patients who are treated with antiretroviral therapy also tend to develop risk factors for cardiovascular complications. They develop abdominal obesity among other changes in body composition, and they suffer insulin resistance and other metabolic complications of dyslipidemia (disorders of lipoprotein metabolism, such as high cholesterol levels). Previous analyses have shown that HIV patients who accumulate abdominal body fat have reduced secretion of growth hormone (GH) - 33% of patients exhibit relative GH deficiency (GHD). It has been suggested that providing these patients with doses of GH could help decrease abdominal fat.

Testing the effects of GH on abdominal fat, Dr. Grinspoon and colleagues studied 56 HIV patients with abdominal fat accumulation and GH deficiency. To determine the impact of GH on the main outcome measures of body composition, lipids, and other metabolic and cardiovascular indicators, the researchers randomly assigned patients to receive GH by injection or matching placebo. A safety analysis included 26 GH patients and 29 placebo patients, and an efficacy analysis included 25 GH patients and 27 placebo patients.

The investigators found that the GH group had a -8.5 percentage change in abdominal fat and the placebo group had a -1.6 percentage change - a significantly larger decrease in the GH group. In addition, the GH group saw trunk-to-lower extremity fat ratio and trunk fat decrease more than the placebo group.

Although triglycerides and diastolic blood pressure (BP) levels improved for the GH group, there was no statistically different change in systolic blood pressure between the two groups and total cholesterol and high density lipoprotein (HDL) cholesterol levels remained stable. The researchers also found that the GH treatment led to higher glucose levels during glucose tolerance testing. Long-term indices of glucose, such as hemoglobin A1c (the oxygen carrying portion of red blood cells that occasionally joins with glucose), were not different between the GH and placebo group, however..

"Data from our randomized, placebo-controlled trial involving a long duration of observation inject a note of caution into the debate regarding the use of GH therapy in the HIV population," note the authors. "Low-dose physiological GH is well-tolerated and results in significant but more modest reduction in visceral adipose tissue [VAT; abdominal fat], but is nonetheless associated with increased glucose levels. Therefore, the therapeutic window to achieve an optimal risk-benefit ratio of GH in individuals with HIV, abdominal fat accumulation, and insulin resistance may be very narrow and difficult to achieve."

They conclude that, "Growth hormone is not yet FDA-approved for the treatment of abdominal fat accumulation in patients with HIV. Other more potent strategies to safely increase GH and reduce VAT, including the use of GH-releasing hormone (GHRH), may be more beneficial. In addition, strategies using diet, exercise, and lifestyle change may be more cost-effective in the long run than GH, particularly in patients with HIV, visceral adiposity, and insulin resistance, in whom changes in glucose may be counterproductive."

Low-Dose Physiological Growth Hormone in Patients With HIV and Abdominal Fat Accumulation: A Randomized Controlled Trial
Janet Lo; Sung Min You; Bridget Canavan; James Liebau; Greg Beltrani; Polyxeni Koutkia; Linda Hemphill; Hang Lee; Steven Grinspoon
JAMA(2008). 300[5]: pp. 509 - 519.
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Written by: Peter M Crosta
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