Short-term growth hormone administration at the time of opportunistic infections in HIV-positive patients.
OBJECTIVE
A 12-week course of recombinant human growth hormone is an effective but expensive therapy for established HIV-related wasting. Wasting in HIV disease is often episodic, coinciding with bouts of acute opportunistic infection. We hypothesized that a short course of growth hormone, targeted at the time of opportunistic infection, might improve protein metabolism thereby reducing lean tissue loss.


METHODS
HIV-infected men with acute opportunistic infections, who received standard antimicrobial treatment for their infection as well as intensive nutritional counselling and oral energy supplements, were randomized to receive growth hormone or placebo for 14 days. Principal assessments were protein metabolism (measured by 13C-leucine infusion), body composition (measured by DEXA) and safety.


RESULTS
There were no significant changes in outcome parameters in the placebo group (n = 11). In the growth hormone group (n = 9), protein catabolic rate decreased by 60% in the fasted state (P = 0.02 versus placebo), lean body mass increased by 2.2 kg (P = 0.03 versus baseline) and fat mass decreased by 0.7 kg (P = 0.002 versus baseline). There was no increase in adverse or serious adverse events in the growth hormone as compared with the placebo group.


CONCLUSIONS
A two-week course of growth hormone at the time of acute opportunistic infection in HIV-infected patients improves protein metabolism and body composition during therapy and appears to be safe. This may represent a rational and economical approach to the use of growth hormone therapy.
St. George's Hospital Medical School, London, UK.
N I
NI
Paton
P J
PJ
Newton
D R
DR
Sharpstone
H M
HM
Ross
J
J
Cotton
A G
AG
Calder
E
E
Milne
M
M
Elia
S
S
Shah
P
P
Engrand
D C
DC
Macallan
B G
BG
Gazzard
G E
GE
Griffin
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000378:metabolism; D000328:Adult; D001823:Body Composition; D004311:Double-Blind Method; D013006:Growth Hormone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D019247:HIV Wasting Syndrome / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D018737:Hand Strength; D019382:Human Growth Hormone; D006801:Humans; D008297:Male; D011506:Proteins / Q000378:metabolism; D011788:Quality of Life; D016896:Treatment Outcome
D011506:Proteins; D019382:Human Growth Hormone; D013006:Growth Hormone