CHANGES IN BODY-COMPOSITION OF HUMAN IMMUNODEFICIENCY VIRUS-INFECTED MALES RECEIVING INSULIN-LIKE GROWTH-FACTOR-I AND GROWTH-HORMONE

Weight loss is a common, persistent characteristic of long term human immunodeficiency virus (HIV-1) infection; its full etiology remains un known. Because treatment with GH has induced nitrogen retention in var ious catabolic conditions, we designed this study to determine whether a moderate dose of insulin-like growth factor I (IGF-I) combined with a low GH dose could impede the catabolic response seen in HIV-1 infec tion. A double blind, placebo-controlled study design was used. Subjec ts in the GH/IGF-I treatment group (n = 44) and control group (n = 22) continued to receive their routine stable antiretroviral therapy. No patient had a recent history of opportunistic infection, malignancy, o r Kaposi's sarcoma and had dietary intakes of at least 25 Cal/kg weigh t . day at study entry. During the la-week study period, dietary instr uction was given, and subjects were encouraged to maintain an intake o f 35 Cal/kg and 1 g protein/kg. All subjects had a body mass index of 19.8 kg/m(2) or less at the time of study entry or a weight loss of 10 % or more of their premorbid weight and a body mass index below 26.1 k g/m(2). The treatment group received 0.34 mg (0.68 mg/day) GH, twice d aily, and 5.0 mg (10 mg/day) IGF-I, twice daily. Changes in body compo sition of total body potassium (TBK), total body nitrogen (TBN), fat-f ree mass (FFM), and body fat (Fat) were examined at 6 and 12 weeks dur ing the treatment period. TBK, TBN, FFM, and Fat for the treatment and placebo groups were, on the average, below normal at study entry. At 6 weeks, the GH/IGF-I group showed a significant increase in FFM (P < 0.0001), a minimal increase in TBK (P < 0.05), and a substantial decre ase in Fat (P < 0.01) compared with baseline values. The loss of body fat continued to be significant (P < 0.01) in the GH/IGF-I group treat ment at 12 weeks, whereas the increase in FFM was minimal (P < 0.05). No significant changes in the mean body composition occurred at 6 or 1 2 weeks in the placebo group. By 12 weeks, neither TBK (body cell mass ) nor TBN (total protein mass) had significantly increased relative to the values at baseline, although the FFM remained elevated. Thus, the combined GH and IGF-I doses used in this study in adult males with HI V-associated weight loss were ineffective in producing a sustained ana bolic response and, in fact, resulted primarily in a significant loss of body fat.