Low-dose growth hormone and human immunodeficiency virus-associated lipodystrophy syndrome: a pilot study.
BACKGROUND
Treatment with high doses (2-6 mg day(-1)) of human growth hormone (hGH) in patients with human immunodeficiency virus (HIV)-associated lipodystrophy syndrome (HALS) has been shown to increase concentrations of total insulin-like growth-factor-I (IGF-I) more than twofold greater than the normal upper range and is accompanied by adverse effects such as joint pain and glucose intolerance.


METHODS
We performed a 16-week open-labelled prospective pilot study in six male HALS patients using a s.c. low-dose hGH, 0.7 mg day(-1), aiming to examine the impact on total and free IGF-I and fat distribution. Glucose metabolism was examined by oral glucose tolerance tests and hyperinsulinaemic euglycaemic clamps.


RESULTS
Total IGF-I increased twofold (P < 0.01) and free IGF-I increased 2.5-fold (P < 0.01) to the level of the normal upper range. HDL-cholesterol increased (P = 0.01). Patients reported improvements of lipodystrophy, which was supported by a decreased waist-to-thigh ratio (P = 0.01), and waist-to-hip ratio (P = 0.06). Ratio of peripheral to trunk soft tissue mass increased (P = 0.01, measured by dual-energy X-ray absorptiometry scans) and a trend towards reduction in percentage of trunk fat was suggested (P = 0.12). Total fat mass, exercise capacity, glucose tolerance, glucose disposal rate and immune status, respectively, did not change (all P > 0.5). The patients did not complain of arthralgia or other known GH-related side-effects.


CONCLUSIONS
Sixteen weeks' treatment of lipodystrophic HIV-infected patients with hGH, 0.7 mg day(-1), increased total and free IGF-I twofold and appeared safe and tolerable. The potential of low-dose hGH in the treatment of HIV-lipodystrophy awaits examination by placebo-controlled, randomized trials.
Andersen
O
O
Hvidovre University Hospital, Copenhagen, Denmark. oandersen@dadlnet.dk
Haugaard
S B
SB
Flyvbjerg
A
A
Andersen
U B
UB
Ørskov
H
H
Madsbad
S
S
Nielsen
J O
JO
Iversen
J
J
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition; D004032:Diet; D002149:Energy Intake; D005951:Glucose Tolerance Test; D039682:HIV-Associated Lipodystrophy Syndrome / Q000188:drug therapy* / Q000378:metabolism; D019382:Human Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies
D001786:Blood Glucose; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I