HIV-positive teenagers with lipodystrophy have lower growth hormone secretion

Michael Carter
Published: 01 July 2003

HIV-positive adolescents who experienced changes in their body shape as a consequence of taking HAART show impaired growth hormone secretion, according to an Italian study published in the July 4th edition of AIDS

The study involved 25 pubescent adolescents (average age 13 – 15 years), all of whom had been treated with HAART regimens containing d4T and 3TC in addition to the protease inhibitor indinavir (22 patients) or nelfinavir. Ten of the adolescents were diagnosed as having visceral adiposity, the other 15 having no physical symptoms.

Investigators at the University of Milan noted that studies have demonstrated a connection between abdominal fat accumulation in adults and impaired secretion of growth hormone. To establish if this, or any other factor, was associated with body fat changes in adolescents, the 25 study participants had fasting blood samples taken to check growth hormone and insulin-like growth factor secretion. Blood lipids were also tested and the teenagers had physical examinations and scans to determine the extent of body-shape change and body mass index.

Results

There were no differences in age, height, weight, body mass index, growth velocity, or HIV treatment history between the adolescents with visceral adiposity and those without.

Eight of the ten patients with visceral adiposity also had fat loss from the cheeks, buttocks or limbs, another symptom of lipodystrophy syndrome, and abdominal fat accumulation, which was associated with breast enlargement in four cases and fat accumulation between the shoulders in another.

Growth hormone secretion was significantly reduced in the adolescents with visceral adiposity (16.39mg/L versus 31.58mg/L in teenagers without visceral adiposity, p=0.002).

Significant differences in body mass were also present. The patients with visceral adiposity showed lower total lean mass (p=0.0025), and in the arms (p=0.024), legs (p=0.008) and higher fat mass as a total (p=0.0038), and in the arms (p=0.028), and trunk (p<0.0001).

There was no difference in fasting HDL and LDL cholesterol, triglycerides, or glucose between the two groups of patients, although fasting insulin levels were significantly higher in the children with visceral adiposity (p=0.01).

The investigators conclude “this is the first reported evidence of abnormal growth hormone physiology in HAART-treated children with visceral fat accumulation”, and that treatment with recombinant human growth hormone should be considered for children with lipodystrophy.

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Reference

Vigano A et al. Impaired growth hormone secretion correlates with visceral adiposity in highly active antiretroviral treated HIV-infected adolescents. AIDS 17: 1435 – 1441, 2003.

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