Short-term growth hormone administration at the time of opportunistic infections in HIV-positive patients

Objectives: A 12-week course of recombinant human growth hormone is an effe ctive but expensive therapy for established HIV-related wasting. Wasting in HIV disease is often episodic, coinciding with bouts of acute opportunisti c infection. We hypothesized that a short course of growth hormone, targete d at the time of opportunistic infection, might improve protein metabolism thereby reducing lean tissue loss. Methods: HIV-infected men with acute opportunistic infections, who received standard antimicrobial treatment for their infection as well as intensive nutritional counselling and oral energy supplements, were randomized to rec eive growth hormone or placebo for 14 days. Principal assessments were prot ein metabolism (measured by C-13-leucine infusion), body composition (measu red by DEXA) and safety. Results: There were no significant changes in outcome parameters in the pla cebo group (n = 11). In the growth hormone group (n = 9), protein catabolic rate decreased by 60% in the fasted state (P = 0.02 versus placebo), lean body mass increased by 2.2 kg (P = 0.03 versus baseline) and fat mass decre ased by 0.7 kg (P = 0.002 versus baseline). There was no increase in advers e or serious adverse events in the growth hormone as compared with the plac ebo group. Conclusions: A two-week course of growth hormone at the time of acute oppor tunistic infection in HIV-infected patients improves protein metabolism and body composition during therapy and appears to be safe. This may represent a rational and economical approach to the use of growth hormone therapy. ( C) 1999 Lippincott Williams & Wilkins.