Growth Hormone for HIV-Related Abdominal Fat Not Effective for All Metabolic Measures

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Title: Growth Hormone for HIV-Related Abdominal Fat Not Effective for All Metabolic Measures
URL: http://www.pslgroup.com/dg/226CCA.htm
Doctor's Guide
August 4, 2008

MEXICO CITY -- August 4, 2008 -- HIV-infected patients with treatment-related abdominal obesity and growth hormone (GH) deficiency who received low-dose GH showed improvement in fat and blood pressure measurements, but worsened glucose levels, according to a study in the August 6 issue of the Journal of the American Medical Association.

Steven Grinspoon, MD, Massachusetts General Hospital, Boston, Massachusetts, presented the findings of the study at a JAMA media briefing at the 17th International AIDS Conference, Mexico City, Mexico.

Dr. Grinspoon and colleagues aimed to determine whether low-dose GH in 56 HIV+ patients with abdominal fat accumulation and GH deficiency improved body composition, lipids, and other metabolic and cardiovascular measures.

Patients were randomly assigned to receive by injection either GH or matching placebo. Safety analyses included 26 patients receiving GH and 29 receiving placebo, and efficacy analysis included 25 patients with GH and 27 with placebo.

The researchers found that abdominal fat decreased significantly in the GH group (-8.5%) compared with the placebo group (-1.6%). Trunk-to-lower extremity fat ratio and trunk fat also decreased in the GH group compared with the placebo group.

Triglycerides and diastolic blood pressure (BP) levels improved with GH, while the change in systolic BP was not statistically different compared with placebo. Total cholesterol and HDL cholesterol levels were unchanged between the 2 groups.

GH increased glucose levels during glucose tolerance testing; however, long-term indices of glucose, haemoglobin A1C, were not different between the groups.

"Data from our randomised, 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," the authors wrote.

"Low-dose physiological GH is well-tolerated and results in significant but more modest reduction in visceral adipose tissue [VAT] 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."

"Other more potent strategies to safely increase GH and reduce VAT, including the use of GH-releasing hormone, 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," the authors wrote.

SOURCE: Journal of the American Medical Association

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