46th ICAAC, San Francisco, 2006

1
46th ICAAC, San Francisco, 2006
Maintained Effect on Body Composition After
Treatment With Recombinant Human Growth Hormone
(r-hGH) in HIV-1 Infected Patients With
Lipodystrophy
H-1898
1 HIV Unit, JW Goethe University, Frankfurt,
Germany 2 Radiology, JW Goethe University Clinic,
Frankfurt, Germany 3 Internistisches Facharzt
Zentrum Stresemannallee, IFS, Frankfurt,
Germany 4 Medizinische Poliklinik, Klinikum der
LMU Munich, Germany
M BICKEL 1, S ZANGOS 2, V JACOBI 2, T LUTZ 3, F
GOEBEL 4, S STASZEWSKI 1, S KLAUKE 3
Introduction
Table 1 Demographic data and HIV-treatment
characteristics of the study participants. Values
are shown as mean values with standard deviation
in brackets if not stated otherwise.
Table 2 Evolution of metabolic parameters and
fat mass measured with MRI in different body
regions during 24 weeks of r-hGH treatment and at
follow-up 9 month after the end of treatment.
Values of are shown as mean values standard
deviation.

• Several studies showed reduction of visceral
  adipose tissue (VAT) using recombinant human
  growth hormone (r-hGH) in HIV-1 patients with
  lipo-dystrophy, but if the effect is maintained
  is unknown.
• In a prospective, randomized study we previously
  studied the effects of r-hGH 4 mg daily (group
  A) vs three times/week (B) over 12 weeks,
  followed by a 2 mg daily maintenance dose for
  additional 12 weeks (1).
• Furthermore concerns about a reduction of
  subcutaneous fat, especially in the facial
  region, and therefore a worsening of the
  lipoatrophy were raised.

Methods

• Fast T1 weighted gradient-echo FLASH MRI
  sequences of the abdomen, the upper leg, at cheek
  and neck level were taken (TR/TE110/4 ms 10
  slices, 8-mm section thickness) were done at
  baseline, week 12, week 24 and at follow up.

VAT visceral fat mass TAT total adipose
tissue MTF mid thigh fat bsl baseline fup
follow-up.
Table 3 Percentage of reduction of the visceral
fat mass (VAT) compared to baseline during 24
weeks of r-hGH treatment and at follow-up 9 month
after end of treatment. Values of are shown as
mean values standard deviation.
Results

• Median time of follow-up was 9 months (6 - 12).
• At follow-up VAT remained overall 18 (17 to
  -53) below baseline
• no difference between group A or B (Difference
  in VAT -21 A vs B -23).
• 11 pts. were treated with a PI and 5 with a
  NNRTI-based regimen. Response to r-hGH after 24
  weeks was similar, but at follow-up the reduction
  of VAT remained higher in the NNRTI compared to
  the PI group (-26 vs -15) (table 2).
• No depletion of subcutaneous fat was seen during
  the follow-up period in all measured areas.
• Fasting glucose, triglycerides, ASAT (sGOT) and
  ALAT (sGPT) were lower at follow-up compared to
  baseline values.

Discussion
Conclusions

• In spite of the regain of VAT after stopping the
  r-hGH treatment found by Engelson et al. (2) and
  in our study, the absolute benefit remains higher
  with a reduction of 19 and 18 respectively as
  compared to the 8.6 reduction reported by
  Kotler et al (3).
• The improved metabolic profile could be a result
  of the decrease of VAT.
• The improvement of glucose values might be
  over-shadowed by the acute insulin-resistance
  caused by r-hGH during treatment and becomes
  detectable after treatment cessation.

• These results suggest that the achieved
  reduction of VAT using r-hGH in lipodystrophic
• HIV patients is in part maintained after a
  median follow-up time of 9 months.
• The continued use of a PI might limit this
  benefit.

References

1. Bickel M, Zangos S, Jacobi V et al. A randomised,
   open-label study to compare two different doses
   of recombinant human growth hormone (r-hGH) on
   fat reduction and fasting metabolic parameters in
   HIV-1 infected patients with lipodystrophy. HIV
   Med. 2006 Sep7(6)397-403..
2. Engelson E, Glesby M, Mendez D et al. Effect of
   recombinant human growth hormone in the treatment
   of visceral fat accumulation in HIV infection. J
   Acquir Immune Defic Syndr 2002 30379-91.
3. Kotler D, Muurahainen N, Grunfeld C et al.
   Effects of growth hormone on abnormal visceral
   adipose tissue accumulation and dyslipidemia in
   HIV-infected patients. J Acquir Immune Defic
   Syndr 2004 35239-52.