Growth Hormone-Releasing Hormone in HIV-Infected Men With Lipodystrophy: A Randomized Controlled Trial

Growth hormone deficiency and visceral fat accumulation are interconnected problems in HIV-infected patients, but directly administering growth hormone carries risks of insulin resistance and glucose intolerance. This JAMA study by Lo, You, Canavan, and colleagues tested whether stimulating the body's own growth hormone production through a GHRH analog could reduce visceral fat while preserving metabolic safety.

The randomized, double-blind, placebo-controlled trial enrolled HIV-infected men with abdominal fat accumulation and reduced growth hormone secretion. Participants received either tesamorelin (GHRH analog) or placebo for 26 weeks. The researchers carefully monitored both body composition changes and metabolic parameters including glucose tolerance.

Tesamorelin reduced visceral adipose tissue by approximately 20%, with significant improvements in the triglyceride-to-HDL cholesterol ratio — a key marker of cardiovascular risk. Growth hormone and IGF-1 levels increased, confirming restoration of the growth hormone axis. Critically, glucose tolerance did not worsen during the treatment period, distinguishing GHRH analog therapy from direct growth hormone administration.

This study, published in one of medicine's most prestigious journals, reinforced the therapeutic rationale for tesamorelin: by stimulating natural, pulsatile growth hormone release rather than providing exogenous growth hormone, GHRH analogs can improve body composition and metabolic markers while maintaining the body's regulatory feedback mechanisms. These findings contributed to the growing evidence base that ultimately supported FDA approval.