title: Treatment of altered body composition in HIV-associated lipodystrophy: comparison of rosiglitazone, pravastatin, and recombinant human growth hormone.
abstract: OBJECTIVE
  Treatment options for HIV-associated lipodystrophy syndrome (HALS) remain limited. The objective of this randomized open-label study was to compare three emerging therapies, rosiglitazone, pravastatin, and growth hormone alone and together, in men and women with HALS.
  
  
  METHODS
  Sixty-four subjects received daily rosiglitazone (4 mg, n = 14), pravastatin (40 mg, n = 11), or rosiglitazone plus pravastatin (n = 13) for 48 weeks or recombinant human growth hormone (rhGH; Serostim 2 mg, 12 weeks, n = 13) alone or combined with rosiglitazone (n = 13). Primary endpoint was body composition change by dual X-ray absorptiometry (DXA) and computed tomography (CT).
  
  
  RESULTS
  Rosiglitazone resulted in slow accrual of limb fat detected by DXA (+444 +/- 186 g; p < .05) but not CT. Pravastatin had no consistent significant effects on body composition, although it reduced total and LDL cholesterol. Negative interactions were observed between pravastatin and rosiglitazone. rhGH reduced abdominal fat by CT (-31 +/- 15 cm2, 26%; p < .05) and DXA (-1597 +/- 383 g, 27%; p < .05) and increased trunk and limb lean mass (+10% and +12%, respectively). However, effects largely disappeared within 12 weeks post treatment. rhGH alone impaired insulin sensitivity but not when combined with rosiglitazone.
  
  
  CONCLUSIONS
  Prolonged rosiglitazone treatment slowly improves lipoatrophy. rhGH rapidly and selectively reduces visceral fat, although effects are short-lived; co-administered rosiglitazone abrogates rhGH-related insulin resistance.
authors.affiliation: Centre for Infection, Division of Cellular & Molecular Medicine, St George's, University of London, Cranmer Terrace, London, United Kingdom. macallan@sgul.ac.uk
authors.forename: Derek C
authors.initials: DC
authors.lastname: Macallan
authors.forename: Christine
authors.initials: C
authors.lastname: Baldwin
authors.forename: Sundihya
authors.initials: S
authors.lastname: Mandalia
authors.forename: Vjera
authors.initials: V
authors.lastname: Pandol-Kaljevic
authors.forename: Nadine
authors.initials: N
authors.lastname: Higgins
authors.forename: Alan
authors.initials: A
authors.lastname: Grundy
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Moyle