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This Month in HIV: A Podcast of Critical News in HIV

A Closer Look at Egrifta, a Newly Approved Treatment for HIV-Associated Belly Fat Gain (Lipohypertrophy)

An Interview With Daniel Berger, M.D.

November 11, 2010

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.

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That's the debate that seems to go on a fair bit among people who have a lot of fat gain and then decide to resort to liposuction, for instance, instead of a diet or nutrition or exercise change in order to resolve the problem.


But when we're talking about this particular type of fat gain, doesn't this tend to be something that people don't really have much control over?

Well, true, certainly if it's due to their HIV infection and due to medication, there is a certain amount of non-control in terms of fat accumulation developing. But I strongly believe that individuals who maintain exercise regimens, who subscribe to a diet such as the Mediterranean type of diet, have a lot less potential for developing the problem in general. They can develop lipoatrophy, in other words, loss of fat. But in terms of lipo-accumulation, I believe that they're less likely, or the severity of what they'll see will be much less than seen otherwise because from just the logical sense: If you're exercising normally, you're going to be burning body fat, oxidizing fatty acids. Your body's going to be working more metabolically efficiently and you'll be using your nutrients more efficiently. Your cells and mitochondria will be working more efficiently.

So then to take a step back, we're looking at a situation where we still have people developing or continuing to have this excess belly fat, this visceral adiposity that you had mentioned. And we suddenly have this new option on the table that can be used to potentially treat it, at least in part.

So for you, as an HIV doctor, what would you recommend for your HIV-positive patients who might be developing fat gain, or who might want to avoid it in the first place? Does it start with diet and nutrition? Is that what you focus on and only resort to Egrifta later on? Or is there a point at which you're like, "You know what? I know this person's been on treatment for 10 years. They've had this for a while. I should just start them on this immediately"?

I think it's going to be patient-specific, knowing your patients and taking them as individuals. So for a patient who has lousy eating habits and doesn't exercise, obviously you want to target them, you want to get them to get into better habits. And also, as I mentioned earlier, we're always looking at the overall benefit in terms of reducing cardiovascular risk for our patients. So that's very much consistent with that line of thinking.


As you said, say you have seen a patient for several years and you've already talked to him or her about a diet, or you know that the patient is not going to be good at that -- just by understanding the patient's personality and habits -- I think that it's then reasonable to try Egrifta. But again, I always believe that we should be counseling our patients in terms of diet and exercise wherever possible.

Also, in terms of reducing cardiovascular risk, if patients have elevated lipids, [then recommend they go] on a statin, for example; if they're a smoker, try to help them to try to quit. All of that is part of trying to reduce the long-term complications that are now being seen in people with HIV as they live longer.

I think that Egrifta is an option for patients that have visceral adiposity. You can use it as first line, or you can use it in combination with some dietary habits or for people that are not going to effectively change dietary habits. I think Egrifta is an option. And I think it's going to be widely used.

Yes, and we'll see how things pan out, particularly over the long term as people begin to use it more frequently.

Daniel Berger is the medical director and the founder of NorthStar Medical Center in Chicago. He's also a clinical associate professor at the College of Medicine at the University of Illinois at Chicago. Dr. Berger, thank you so much for taking the time to talk to us.

This transcript has been lightly edited for clarity.

Myles Helfand is the editorial director of and

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Copyright © 2010 The HealthCentral Network, Inc. All rights reserved. Podcast disclaimer.

This podcast is a part of the series This Month in HIV. To subscribe to this series, click here.


This article was provided by TheBody. It is a part of the publication This Month in HIV.
See Also
An HIVer's Guide to Metabolic Complications
More on Egrifta (Tesamorelin)

Reader Comments:

Comment by: Prince (Detroit) Sun., Mar. 3, 2013 at 9:51 pm UTC
Hi everybody I have been on Egrifta for a few months now which my insurance does cover . I love it ! I began to see results in the first month. I've lost 3inches in my belly while da rest of my body has become more toned .Just would like to add my penis appears larger . Good for me lol . But honestly the only sides effects I've noticed is lite muscle pain. Lite like a did I short workout and I only feel the life muscle pain if I have a long stressful day. In conclusion Egrifta is a hgh so long term effects is up to each persons individual body .. If your concussed by my example of long term effects just picture yourself and or your body before you were diagnosed . That's your long term goal and effect .
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Comment by: Robert (Los Angeles, Calif.) Thu., Nov. 18, 2010 at 9:19 am UTC
Appreciate your efforts, but the most important questions were not asked. Like who will pay for this. Unnecessarily long and complicated.
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Comment by: Jerry Robbins (St Petersburg FL) Wed., Nov. 17, 2010 at 8:44 am UTC
Would it not help facial loss as well as get rid of belly fat,as it is a growth hormone. Actually better supposedly than serostim.
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Comment by: Harry C. (Kenner, La) Tue., Nov. 16, 2010 at 3:06 pm UTC
Does Medicare Advantage Plans cover this medication and does ADAP cover it while you are doughnut hole? Is there a Patient assistance program for this medication for people with HIV/Aids?
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Comment by: laila (Boston) Sat., Nov. 13, 2010 at 10:53 am UTC
Why can't you guys speak regular English and not medical English? This is full of language that is impossible to understand!
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Comment by: REF (ATLANTA GA) Sat., Nov. 13, 2010 at 10:41 am UTC
FYI The cost of this medication is about $2000 a month. Sure hope insurance will cover it????
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