HIV Infections, Lipodystrophy
Conditions
Keywords
HIV, immune stimulation, lipodystrophy, growth hormone, recombinant growth hormone, Treatment Experienced
Brief summary
The purpose of this study is to investigate the effect of low-dose human growth hormone therapy on immune status and fat morphology.
Detailed description
Following the introduction of highly active antiretroviral therapy (HAART) in the mid-nineties, the improvement in the clinical course of HIV has lead to a dramatic reduction in morbidity and mortality. However, a growing concern has been the emergence of an increasing number of drug therapy failure, mainly caused by rebounding virus. This effect in turn is prompted respectively by developing resistance and failing compliance mainly due to early or late adverse reactions. These adverse reactions mainly consists of a number of metabolic and morphologic changes, known as HIV associated lipodystrophy syndrome (HALS) and affects approximately 40 % of HIV infected patients on HAART. HALS is characterized by lipoatrophy on extremities, gluteal and facial regions combined with intraabdominal lipoaccumulation, buffalo hump and lipomas. Thus, despite progress in the development of new drugs with new targets and resistance profiles the need for agents with immune modulating properties is evident, both as a way to overcome the problems of resistance and hopefully modify treatment regimens in order to reduce the exposure to late adverse reactions caused by HAART. A number of studies have addressed the problems of modulating the immune response during HIV infection. Results are promising but a major obstacle seems to be adverse effects. In the pre-HAART era high dose human growth hormone (hGH) therapy has been used for HIV wasting and in the HAART era the impact on fat distribution in HIV infected patients have been investigated based on the lipolytic properties of hGH. However high dosage of hGH has been associated with severe adverse effects limiting the usefulness in daily clinical practice. One recent study demonstrated increments in thymic mass and a rise in the number of circulating naïve CD4 T cells upon treatment with high dose hGH. Our group has conducted a 60 week pilot study with daily injection of 0.7 mg genotropin, demonstrating an immune stimulating effect as well as an increased limb fat/truncal fat ratio, without metabolic and clinically recognizable side effects. Based on these findings we plan to perform a randomized, double blind, prospective, interventional study including 50 HIV infected patients on HAART, investigating the effect of low dose hGH on immune status and fat distribution.
Interventions
DRUGPlacebo
Placebo, 0.7 mg/day injected subcutaneously
DRUGGenotropin (human recombinant Growth hormone)
Genotropin, 0.7 mg/day injected subcutaneously
Sponsors
Pfizer
Hvidovre University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
MALE
Age
21 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Male * Caucasian race * Age \>21 years, \<60 years * HIV-1 infection * HAART treated \> 12 months * HIV-RNA \< 100 copies/ml * CD4 count \> 200 * Fasting plasma glucose \< 6.1 mM * Stable weight
Exclusion criteria
* BMI \> 28 kg/m2 and BMI \< 18.5 kg/m2 * Wasting or AIDS defining disease * Severe chronic diseases other than HIV * Cancer, previous transplantation * Previous AMI * Diabetes * Hormonal substitution therapy * Lipid lowering or antidiabetic therapy within 3 months * Abuse of narcotics or alcohol * Major psychiatric disorders * Adverse reactions towards Genotropin * Calcium-ion \< 1.15 or \> 1.35 mM * D-vitamin \< 19 nM * TSH \< 0.1 or \> 10 mIU/l
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Impact of hGH 0.7 mg/day on number of mature and naïve CD4 cells in HIV patients at 9 months | 9 months |
Secondary
| Measure | Time frame |
|---|---|
| Impact of hGH 0.7 mg/day at 9 months on fat distribution as measured with CT and DEXA scans | 9 months |
| Impact of hGH 0.7 mg/day at 9 months on glucose metabolism i.e.glucose tolerance, insulin sensitivity and beta cell function as measured by OGTT | 9 months |
| Impact of hGH 0.7 mg/day at 9 months on insulin sensitivity as measured by hyperinsulinaemic euglycaemic clamp | 9 months |
| Impact of hGH 0.7 mg/day at 9 months on thymic size | 9 months |
| Impact of hGH 0.7 mg/day at 9 months on quality of life and adherence to HAART | 9 months |
| Impact of hGH 0.7 mg/day at 9 months on cytokines | 9 months |
| Impact of hGH 0.7 mg/day at 9 months on safety parameters | 9 months |
| Impact of hGH 0.7 mg/day at 9 months on lipid profile | 9 months |
Countries
Denmark
Outcome results
None listed