my personal edition > aids and hiv > news


  E-Mail this DGDispatch to a colleague

DGDispatch

Growth Hormone Replacement Reduces Obesity and Improves Diastolic Blood Pressure in Patients With HIV: Presented at CROI

By Maria Bishop

BOSTON, MA -- February 8, 2008 -- Growth hormone (GH) replacement can significantly reduce visceral fat and truncal obesity, as well as triglyceride levels and diastolic blood pressure in patients with HIV-associated lipodystrophy, according to results presented here at the 15th Conference on Retroviruses and Opportunistic Infections (CROI).

Excess accumulation of truncal fat, including visceral adipose tissue, in HIV-infected persons is associated with a number of risks to health and psychosocial well being.

The 18-month prospective trial was presented by coauthor Steven Grinspoon, MD, Associate Professor of Medicine, and Director, Massachusetts General Hospital (MGH) Program in Nutritional Metabolism, Neuroendocrine Clinical Center, MGH, Boston, Massachusetts.

Lipodystrophy in patients with HIV is associated with impaired glucose tolerance and increased cardiovascular risk. In addition, HIV-infected patients with low GH levels are more likely to have poor response to HIV treatment than those with higher GH levels.

Dr. Grinspoon and colleagues enrolled 56 HIV-infected patients with lipodystrophy and peak GH levels of less than 7.5 ng/mL.

Subjects were randomized in a double-blind fashion to either low-dose GH 2 to 6 mcg/kg/day (average dose 4.1 mcg/kg/day) or placebo administered daily subcutaneously to achieve a target insulin-like growth factor 1 (IGF-1) level in the upper quartile of normal.

"Patients were titrated upward very carefully, and these were very low, physiologic doses," Dr. Grinspoon explained.

Results were significant, but modest, according to the authors. There was a specific reduction in visceral adipose tissue, with a 9% difference between the treatment and placebo groups (-22 vs -4 cm²; P =.05).

The reduction in diastolic blood pressure in the active treatment arm was also significant (-3 vs +4 mm Hg; P =.006).

Despite the physiologic dosing of GH in this trial, however, the hormone had a highly significant effect on 2-hour post-oral glucose challenge (+16 vs -4 mg/dL, P =.009). "Patients with impaired glucose tolerance were more susceptible to the change in glucose with GH," Dr. Grinspoon noted.

Interestingly, carotid intima-media thickness did not change with GH treatment compared with placebo, but the difference was not statistically significant (.003 vs -.003 mm; P =.78).

GH replacement was well tolerated, with the frequency of GH-related adverse effects similar to placebo (GH, 22% vs placebo, 28%; P =.64). There were no excess GH-related adverse effects, in contrast with other recently published reports.


[Presentation title: Effects of 18-Month Physiological GH Replacement in Relatively GH-Deficient Patients With HIV Lipodystrophy. Abstract 146LB]

E-Mail this DGDispatch to a colleague

To print, use this version