Recombinant human growth hormone: rationale for use in the treatment of HIV-associated lipodystrophy.
The role of hormonal and metabolic alterations in HIV-associated lipodystrophy syndrome is not yet clear. In patients with HIV-1 undergoing antiretroviral treatment, lipodystrophy is associated with peripheral fat wasting and central adiposity, dyslipidemia, insulin resistance, and increased intramuscular fat accumulation. In HIV lipodystrophy, changes in fat distribution are heterogeneous and can include reduced subcutaneous fat as well as increased visceral fat. In the literature, there is evidence showing that overnight growth hormone (GH) secretion and pulse amplitude decrease in patients with HIV lipodystrophy, with rates of response to standardized GH stimulation being abnormal in at least 20% of these patients. Excess accumulation of visceral fat, central obesity, and increased intra-abdominal adiposity are also typical features of patients with GH deficiency. Recombinant human GH (rhGH) is a potential treatment to diminish excess visceral fat. Our group recently demonstrated that GH therapy in HIV-infected patients with syndromes of fat accumulation produced a significant decrease in body fat and a gain in lean tissue. In this article, we discuss the origin of lipodystrophy in HIV patients, and the use of rhGH treatment (benefits and adverse effects) in HIV-related lipodystrophy.
Benedini
Stefano
S
Clinical Research Unit II, San Raffaele Scientific Institute, Milan, Italy.
Terruzzi
Ileana
I
Lazzarin
Adriano
A
Luzi
Livio
L
D000273:Adipose Tissue / Q000187:drug effects* / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000139:chemically induced; D003920:Diabetes Mellitus / Q000139:chemically induced; D039682:HIV-Associated Lipodystrophy Syndrome / Q000188:drug therapy* / Q000378:metabolism; D019382:Human Growth Hormone / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use*; D006801:Humans; D007333:Insulin Resistance; D009369:Neoplasms / Q000139:chemically induced; D011994:Recombinant Proteins / Q000627:therapeutic use; D018570:Risk Assessment; D016896:Treatment Outcome
D011994:Recombinant Proteins; D019382:Human Growth Hormone