July 12, 2004 (Bangkok, Thailand) -- Increasing the level of growth hormone in people with HIV appears to show promise in treating fat redistribution syndrome that afflicts them.
"For the first time, we have shown that a substance that stimulates the body to make its own growth hormone results in both cosmetic and health benefits for people who suffer from HIV lipodystrophy," says Steven Grinspoon, MD, associate professor of medicine at Harvard Medical School. "Currently, there is no treatment for the condition."
Grinspoon tells WebMD that in 1998, doctors began noticing an unexpected side effect in people taking HIV medications. In more than half of patients on highly active antiretroviral therapy, the drugs throw a monkey wrench into the way the body deals with fats and cholesterol. People treated with a combination of these antiviral medications develop a gaunt appearance as fat wastes away from the face, arms, and legs. Lean body mass is also lost. These changes are also accompanied by what is known as the metabolic syndrome -- abnormal cholesterol, resistant to the action of insulin and central or abdominal obesity. This increases the risk of heart disease and diabetes.
It's not just a cosmetic problem, he explains. Women often suffer from painful fat gain in the breasts, he says, and in both sexes, fat piles up around the internal organs, particularly the abdomen which is linked to heart disease risk.
"Fat accumulates deep in the belly, increasing the risk of cardiovascular disease," Grinspoon says. Cholesterol levels can skyrocket and some people develop insulin resistance, a precursor of diabetes, he says.
Several years ago, Grinspoon found that people with HIV, treated with the combination of antiviral medications, who had the greatest accumulation of fat in the belly, had the lowest levels of growth hormone. And that findings, he says, led his team to hypothesize that increasing growth hormone in these patients might combat the fat redistribution problem which appears to increase the risk of heart disease and diabetes.
Which is just what happened.
In a study that appears in a special HIV/AIDS issue of the Journal of the American Medical Association, published in conjunction with the International AIDS Conference here, Grinspoon reports that giving growth-hormone-releasing hormone (GHRH) to a group of men with HIV lipodystrophy significantly lowered dangerous fat lumps around the belly -- with no negative side effects such as the development of high blood sugars seen occasionally with the use of growth hormone.
"No one has done this before," he tells WebMD. "We gave a substance that stimulates the body to make its own growth hormone, rather than giving growth hormone itself, as it's safer, more natural.
"We now have proof that augmenting low growth hormone levels in this way has the potential to reverse the abnormal body composition that characterizes HIV lipodystrophy," Grinspoon says.
In the study, 31 men with HIV lipodystrophy injected themselves twice daily with either growth hormone-releasing hormone or placebo for 12 weeks.
Looking and Feeling Better
"As expected, levels of growth hormone significantly increased in the men who received the treatment," Grinspoon says. "But more importantly, there was a redistribution of fat away from the abdomen -- and increases in fat in the legs and arms.
"The redistribution of fat away from the abdomen reflects a change toward a more healthy heart health profile," Grinspoon says.
Also, patients who received the treatment said they thought they looked better and "they felt better about themselves," he says.
Jose Luis, MD, a clinician at Ramon y Cajal Hospital in Madrid, Spain, who presented a study at the meeting on the psychological effects of HIV lipodystrophy, praised the study.
"There are many psychological repercussions to the condition, including social distress and anxiety," he tells WebMD. "So treatments that help patients feel better have a host of benefits."
Luis said he hopes that with longer treatment, the substance will also help to fill out the gaunt faces of many sufferers. "Facial [wasting] has been shown to be one of the most distressing aspects of the condition, so hopefully this treatment can help that too."
Grinspoon says the next step is a larger, longer study.