ANABOLIC EFFECTS OF RECOMBINANT HUMAN GROWTH-HORMONE IN PATIENTS WITHWASTING ASSOCIATED WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Body wasting, characterized by disproportionate loss of body cell mass , is a feature of many chronic diseases, including infection with the human immunodeficiency virus (HIV). Therapies that merely increase ene rgy intake do not consistently restore body cell mass in patients with the wasting syndrome. Because treatment with GH has induced nitrogen (N) retention in catabolic patients after surgery, burns, cancer, and hypocaloric feeding, we designed this study to determine whether GH co uld also produce an anabolic response in persons with HIV-associated w eight loss. Six HIV-positive (HIV+) men with an average weight loss of 19% and six healthy weight-stable controls (HIV-) were hospitalized o n a metabolic ward, where they consumed a constant metabolic diet duri ng successive 5-day precontrol, 7-day baseline, and 7-day treatment [r ecombinant human GH (rhGH), 0.1 mg/kg . day] periods. The effects of r hGH on body weight, N and electrolyte excretion, energy expenditure, s ubstrate oxidation, and integrated lipid and carbohydrate metabolism w ere assessed. Body weight increased promptly and progressively during treatment (2.0 +/- 0.3 and 1.6 +/- 0.2 kg in HIV+ and HIV-, respective ly). Urinary N excretion decreased by 288 +/- 17 and 287 +/- 42 mmol/d ay in HIV+ and HIV-, respectively. Resting energy expenditure increase d by 7.5% in both groups. Protein oxidation decreased, whereas lipid o xidation increased significantly. Glucose flux increased, and modest i ncreases in fasting plasma triglyceride, glucose, and insulin levels w ere observed. Thus, short term rhGH treatment increased both protein a nabolism and protein-sparing lipid oxidation, effects that should incr ease body cell mass if sustained during chronic therapy.