GH deficiency in HIV-infected patients with lipodystrophy: preliminary data on the effects of r-hGH treatment on body composition
Lucia Zirilli1, Gabriella Orlando2, Giulia Brigante1, Nicola Squillace2, Chiara Diazzi1, Cesare Carani1, Giovanni Guaraldi2 & Vincenzo Rochira1
Introduction: HIV-infected patients often display a moderate to severe GH deficiency (GHD). To investigate the effects of r-hGH on hormonal parameters and body composition in patients with HIV-related lipodystrophy (HIV-r-L) and concomitant GHD, we studied 60 patients with HIV-r-L, 28 male and 32 females aged 1865 years. According to their response to GHRH+Arginine (GH peak assumed to be normal when >7.5 ng/ml) patients were assigned to the following 3 groups: Group 1, 35 subjects with a normal GH peak after GHRH+Arg (>7.5); Group 2, 10 subjects with GHD (peak<7.5) treated with a low dose of r-hGH (0.018 mg/kg/die), Group 3, 15 subjects with GHD (peak<7.5) not treated with r-hGH.
Methods: Hormones: GH, IGF-1, IGFBP-3; abdominal CT scan for VAT and SAT measurement; DEXA for the measurement of lean and fat body mass. Measurements were performed at baseline and after 24 months.
Results: Serum IGF-1 (mean+S.D.: 130.2±48.2 at baseline, 175.1±55.4 ng/ml at 24 months; P<0.01) and IGFBP3 (mean+S.D.: 2901.16±1328.4 at baseline 4315.6±1150.3 ng/ml at 24 months; P<0.0001) increased significantly only in Group 2, as expected. VAT decreased in Group 2 (from 195.3±75.3 to 158.3±46.9 cm2), but the difference was not significant, while it increased significantly in Group 3 (from 158.3±79.6 to 201.7±88.9 cm2; P=0.02). The same trend was evident for SAT that increased also in Group 1.
Conclusions: The replacement treatment with r-hGH of patients with HIV-r-L and concomitant GHD may be effective in controlling body composition and to prevent fat accumulation, an event that usually occur in patients with HIV-r-L. In particular, the reduction of VAT seems to be higher in patients with higher fat accumulation at baseline.