HIV-infection and its treatment are often associated with an increase in belly fat, as well as abnormal cholesterol and problems metabolizing sugar. People with HIV infection and increased belly fat often have decreased growth hormone (GH) levels. Low GH levels may contribute independently to increased belly fat and to increased cardiovascular risk through effects on sugar metabolism, inflammation, and other mechanisms. Tesamorelin, a growth hormone releasing hormone (GHRH) analogue, has been shown to to reduce belly fat in patients with HIV-associated abdominal fat accumulation. However, the effects of tesamorelin on fat accumulation in the liver and muscle, sugar metabolism, and cardiovascular health are not yet known. The current study is designed to determine the effects of tesamorelin treatment on fat accumulation in the muscle and liver, insulin sensitivity and sugar metabolism, and markers of cardiovascular health including blood vessel thickness (carotid intima media thickness \[cIMT\]) and markers of inflammation in the body. The investigators hypothesize that tesamorelin will decrease fat accumulation in the liver and muscle and will decrease markers of inflammation, with either neutral or beneficial effects on glucose metabolism.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
54
Tesamorelin (growth hormone releasing hormone) 2mg daily given by subcutaneous injection x 6 months during randomized phase, followed by 6 months of open-label tesamorelin at same dose
Placebo 2mg daily given by subcutaneous injection for the first 6 months of the study, followed by an open-label phase of 6 months of tesamorelin (growth hormone releasing hormone) treatment, 2mg daily given by subcutaneous injection
Massachusetts General Hospital
Boston, Massachusetts, United States
Liver Fat
Hepatic fat as measured by magnetic resonance (MR) spectroscopy, and expressed by normalizing lipid to water and expressing as a percent (lipid-to-water percent).
Time frame: 6 months
Visceral Adipose Tissue
Change in visceral adipose tissue area as measured by single-slice computed tomography (CT) scan at the L4 vertebra.
Time frame: 6 months
Intramyocellular Lipid
Intramyocellular lipid (IMCL) as measured by magnetic resonance (MR) spectroscopy of the calf. Soleus IMCL normalized to creatinine (IMCL/Cr based on areas determined by spectroscopy) was measured. The change over 6 months is reported.
Time frame: 6 months
Endogenous Growth Hormone Secretion
Endogenous growth hormone (GH) concentrations measured by overnight frequent blood sampling every 20 minutes. Mean overnight GH concentration is given.
Time frame: 6 months
Insulin Sensitivity
In a subgroup of 1/2 of the subjects, euglycemic hyperinsulinemic clamp will be performed to assess insulin-stimulated glucose uptake. Insulin stimulated glucose uptake (M) calculated using the method of DeFronzo is shown.
Time frame: 6 months
HbA1c
Hemoglobin A1c.
Time frame: 6 months
Insulin Like Growth Factor 1 (IGF-I)
Insulin Like Growth Factor 1 (IGF-I).
Time frame: 6 months
Lipid Panel
Fasting lipids. Triglyceride value is given.
Time frame: 6 months
Carotid Intimal Medial Thickness (cIMT)
Carotid Intimal Medial Thickness (cIMT).
Time frame: 6 months
Glucose Tolerance
Glucose tolerance as measured by standard oral glucose tolerance test. 2-hour glucose is given.
Time frame: 6 months
Adiponectin
adiponectin.
Time frame: 6 months
Hemostatic Markers
Tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) measured in serum.
Time frame: 6 months
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