Pathogenesis and treatment of HIV lipohypertrophy.
OBJECTIVE
This review addresses our current understanding of the pathogenesis of HIV-associated lipohypertrophy and describes an evidence-based approach to treatment.


RESULTS
Although the pathogenesis of HIV-associated lipohypertrophy remains elusive, recent clinical and laboratory investigations in fatty acid metabolism and growth hormone dynamics have furthered our understanding of the condition. These findings have also paved the way for new therapeutic interventions, of which tesamorelin, an analog of growth hormone-releasing hormone (GHRH), has gained recognition as a promising treatment strategy against visceral fat accumulation. Recent randomized placebo-controlled trials of tesamorelin demonstrated significant reductions in visceral adipose tissue, improvement in lipid parameters, and minimal adverse effects on glucose tolerance. Optimal therapeutic dosing and treatment duration, though, are not yet known. Whether treatment with GHRH-analogs will translate into improved long-term metabolic and cardiovascular outcomes also remains to be seen.


CONCLUSIONS
Although the pathogenesis of HIV lipohypertrophy remains unclear, several theories and observations have led to the development of treatment strategies to counter fat accumulation and its accompanying metabolic complications. Based on clinical trials, analogs of the growth hormone (GH)/GHRH axis appear to be most effective in reducing visceral adipose tissue.
Division of Endocrinology, Department of Medicine, Weill Cornell Medical Center, New York, New York, USA.
Vivien L
VL
Leung
Marshall J
MJ
Glesby
D013007:Growth Hormone-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D015658:HIV Infections / Q000150:complications*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000188:drug therapy* / Q000209:etiology*; D006728:Hormones / Q000008:administration & dosage*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D006728:Hormones; D013007:Growth Hormone-Releasing Hormone; C479538:tesamorelin