Effects of Tesamorelin on Visceral Fat and Liver Fat in HIV-Infected Patients With Abdominal Fat Accumulation

Visceral adipose tissue (VAT) accumulation is a serious metabolic complication in HIV-infected patients on antiretroviral therapy, associated with increased cardiovascular risk and metabolic dysfunction. This study by Falutz, Allas, Blot, and colleagues, published in the Journal of Acquired Immune Deficiency Syndromes, evaluated whether tesamorelin — a growth hormone-releasing hormone analog — could safely reduce this visceral fat burden.

The researchers conducted a randomized, double-blind, placebo-controlled trial in HIV-infected patients with abdominal fat accumulation. Participants received either tesamorelin 2 mg or placebo via daily subcutaneous injection for 26 weeks. The primary endpoint was change in visceral adipose tissue measured by CT scan.

Tesamorelin produced a significant 15.2% reduction in visceral adipose tissue compared to a 5% increase in the placebo group. Trunk fat also decreased significantly. The treatment improved triglyceride levels and the triglyceride-to-HDL cholesterol ratio, indicating meaningful metabolic benefits. IGF-1 levels increased as expected with growth hormone stimulation but remained within the normal physiological range.

The safety profile was favorable. The most common adverse events were injection site reactions (erythema, irritation), which were generally mild. No significant changes in glucose tolerance were observed, addressing a key safety concern with growth hormone-related therapies. This study provided pivotal evidence supporting tesamorelin's FDA approval and established it as an effective treatment for HIV-associated lipodystrophy.