In a preliminary study, HIV-infected patients with excess abdominal fat who received the growth hormone-releasing hormone analog tesamorelin for 6 months experienced modest reductions in liver fat, according to a study in the July 23/30 issue of JAMA, a theme issue on HIV/AIDS. Patients infected with HIV demonstrate a high prevalence of nonalcoholic fatty liver disease, estimated at 30 percent to 40 percent. The issue is being released early to coincide with the International AIDS Conference.
In human immunodeficiency virus (HIV) infection, abdominal fat accumulation is associated with ectopic (out of place) fat accumulation in the liver. Nonalcoholic fatty liver disease (NAFLD) may progress to end-stage liver disease and liver cancer. To date, there are no approved pharmacologic strategies to reduce liver fat. Tesamorelin specifically targets abdominal fat reduction but its effects on liver fat are unknown, according to background information in the article.
Takara L. Stanley, M.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues randomly assigned 50 antiretroviral-treated HIV-infected men and women with abdominal fat accumulation to receive tesamorelin (n=28), or placebo (n=22), subcutaneously daily for 6 months.
The researchers found a modest but statistically significant decrease in liver fat with tesamorelin. Hepatic lipid to water percentage (a measure of liver fat), decreased in the tesamorelin group (median, -2.0 percent) compared with placebo (median, 0.9 percent). In addition, there was a significant reduction in abdominal fat: the average change was -9.9 percent with tesamorelin vs 6.6 percent with placebo.
"The decrease in liver fat in this study suggests that strategies to reduce visceral adiposity merit further investigation in HIV-infected patients with NAFLD, a condition for which there are no approved treatments. Importantly, NAFLD is associated with visceral adiposity and other metabolic abnormalities in HIV," the authors write.
"Further studies are needed to determine the clinical importance and long-term consequences of these findings."