HGH in Treating Fat Redistribution or Lipodystrophy

Effect of human growth hormone in the treatment of visceral fat accumulation in HIV infection: interim analysis (abstract 006 at 1st Lipodystrophy Conference, San Diego, June 29)

Jules Levin

Don Kotler and co-investigators reported on a small pilot open-label study to determine the safety and efficacy of recombinant human growth hormone, 6 mg once daily for 6 months, in HIV-infected people with fat redistribution and metabolic alterations. The syndrome of fat redistribution frequently consists of wasting (loss of subcutaneous fat) in the face, arms, and legs. This often is accompanied by increased deposits of fat (visceral fat) in the stomach, enlargement of breasts in women, or fat deposits in other areas such as on the back of the neck called buffalo hump.

Thirty-six subjects, 26 men and 4 women, have accrued into the study and are being followed.

At baseline, both men and women had -

* increased visceral fat (VAT) of 5.6 compared to subcutaneous fat (SAT) which was 14.4. The average VAT:SAT ratio was 0.39.

After 3 months of follow-up while taking HGH-

* visceral fat decreased by about 50% to 2.8 (n=8). This was quantified by dual x-ray absorbtiometry (DXA) and total body magnetic resonance imaging (MRI).

* subcutaneous fat did not increase. An increase in subcutaneous fat is what is needed to improve the loss of this fat in the face, legs, and arms.

* Fasting triglycerides decreased significantly by 3 months from 423 to 276

* Fasting glucose increased significantly from 91 to 115. Suggesting that if a person has a pre-existing concern about sugar (diabetes in family, elevated glucose) HGH may raise their glucose.

* Serum cholesterol did not change significantly (233 to 204).

* Some joint stiffness was also reported

Kotler concluded that visceral fat decreases during therapy with HGH and did not increase lipids. Lower doses og HGH should be exlored.

A few other studies (Torres & Unger; Mauss) have reported HGH reduces visceral fat abnormally accumulated in stomach or as hump on back of neck in HIV-infected individuals but no benefit has been shown in these studies to peripheral lipodystrophy: wasting of face, arms, legs.

The data from the Kotler study was short-term. Gabe Torres study was not a randomized study but was observational in nature where a small number of patients in his medical practice received HGH for about 6 months to 1-2 years. There was no obsevation of reversal of wasting in the face, arms, or legs, although reduction in fat deposite were observed. There is no indication from prior experience with HGH nor is there a theoretical basis based on the understanding of how HGH works to expect that peripheral wasting would reverse.