Although the use of highly active antiretroviral therapy (HAART) usually leads to dramatic recovery from AIDS-related infections, HAART is associated with side effects, particularly the following:

• Fat redistribution

• Fat accumulation at the base of the neck (buffalo hump)

• Fat wasting

• Increased levels of sugar (glucose) in the blood

• Increased levels of fatty substances -- cholesterol and triglycerides -- in the blood

Collectively these changes are called the lipodystrophy syndrome. The increased levels of fat, sugar and insulin in the blood increase the risk of developing heart disease, diabetes and possibly other complications.

Research teams are conducting studies to try and find the precise cause(s) of the lipodystrophy syndrome. Readers should note that there may be more than one syndrome occurring at the same time and there may not be a simple fix for this problem.

Because the use of growth hormone (GH) has helped reduce the amount of fat in some people, particularly males, one research team in San Francisco conducted a small study of GH injections in people with HIV/AIDS (PHAs) who experienced fat accumulation. We now present preliminary results from this study. A more detailed report will appear in a future issue of the CATIE newsletter TreatmentUpdate (www.catie.ca/tu.nsf).

Study Details and Results

Researchers reported results from six male PHAs who received GH at a dose of 3mg per day injected under the skin. Over the course of six months of GH use, the drug reduced buffalo humps and excess fat that had built up in their abdomens.

However, GH was not without side effects. During the first month, subjects developed higher-than-normal levels of glucose as well as the hormone insulin in their blood. By the end of the study, these problems had cleared in all but one subject who had pre-existing diabetes.

The researchers noted that the dose of GH used in the study was high and that future studies should test lower doses of the drug. As well, because of GHs potential to cause blood sugar problems in some people, doctors planning to prescribe the drug should order "oral glucose tolerance tests" to help them identify PHAs who are at risk for this side effect. GH is licensed in North America for the treatment of HIV-related wasting, however it is very expensive.

References

1. Lo J.C., Mulligan K., Noor M.A., et al. The effects of recombinant human growth hormone on body composition and glucose metabolism in HIV-infected patients with fat accumulation. Journal of Clinical Endocrinology and Metabolism 2001;86(8):3480-3487.

2. Münzer T., Harman S.M., Hees P., et al. Effect of GH and/or sex steroid administration on abdominal subcutaneous and visceral fat in healthy aged women and men. Journal of Clinical Endocrinology and Metabolism 2001;86(8):3604-3610.