APPLIED NUTRITIONAL INVESTIGATION
Weight-Losing HIV-Infected Patients on
Recombinant Human Growth Hormone for 12 wk:
A National Study
Silvano Cominelli, MD, Comasia A. Raguso, MD, Laurie Karsegard, MS,
Bernard Hirschel, MD, Rolf Gaillard, MD, Laurence Genton, MD, and
Claude Pichard, MD, PhD
From the Department of Clinical Nutrition and the Department of Infectious Diseases,
Geneva University Hospital, Geneva, Switzerland; and the Department of Endocrinology
and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
OBJECTIVE: In patients with human immunodeﬁciency virus, body weight (BW) loss, due mainly to loss
of fat-free mass, is associated with progression of disease and mortality. Recombinant human growth
hormone (rhGH) may promote BW gain by restoring FFM.
METHODS: We investigated the results of adding to highly active antiretroviral therapy of routine rhGH
treatment in 34 patients with human immunodeﬁciency virus who had lost 5% to 20% of their usual BWs.
They were recruited by their physicians in Switzerland and were instructed to self-administer the drug.
Patients were given 6 mg of rhGH each day for 12 wk. BW and body composition, measured by
bioelectrical impedance analysis (50 kHz, tetrapolar), were recorded at baseline and at 4, 8, and 12 wk of
RESULTS: At week 12, BW gain averaged 3.0 Ϯ 0.5 kg (P Ͻ 0.001), fat-free mass gain was 4.8 Ϯ 0.5
kg (P ϭ 0.001), and body fat mass loss was 1.8 Ϯ 0.4 kg (P ϭ 0.008). BW and fat-free mass increases
and FM decrease were evident by week 4 and tended to plateau by week 8. Therapy was well tolerated;
one patient developed carpal tunnel syndrome. Five patients abandoned the study for reasons unrelated to
the rhGH treatment.
CONCLUSION: Our data strongly support the use of rhGH in the treatment of unintentional BW loss
associated with human immunodeﬁciency virus. The low rate of dropouts and the low incidence of side
effects make the use of rhGH suitable for primary care management. Nutrition 2002;18:583–586.
©Elsevier Science Inc. 2002
KEY WORDS: growth hormone, body weight loss associated with human immunodeﬁciency virus, highly
active antiretroviral therapy, bioelectrical impedance analysis, fat-free mass
Body weight (BW) depends on the equilibrium between nutritional
intake and requirements and between intestinal absorption and
anabolic capacity. This equilibrium is impaired in patients with
BW loss associated with human immunodeﬁciency virus (HIV)
through multiple factors such as opportunistic infections, reduced
energy intake, malabsorption, HIV-related hypermetabolism, and
In HIV-infected patients unintentional
BW loss and reduced quality of life,
and progression of the
disease and mortality
correlate strongly. BW loss predicts mor-
tality independently of viral load and CD4
recent study showed that a BW loss of only 5% predicts an
increased risk of opportunistic infections and death.
HIV-associated wasting includes depletion of fat and lean
but it is the loss of lean tissue that determines the asso-
ciation between mortality and weight loss.
Therefore, the main
goal of treating patients affected by HIV-associated BW loss
should be to delay or reverse the loss of lean tissue.
Among the available options in HIV-associated BW loss, re-
combinant human growth hormone (rhGH) enhanced nitrogen
retention in a short-term metabolic ward study
fat-free mass (FFM) through increased protein synthesis in a
12-wk, double-blind, placebo-controlled study.
Since the study of Schambelan et al.,
HIV therapy has been
empowered by the introduction of new antiviral drugs such as
protease inhibitors (PIs) and non-nucleoside reverse-transcriptase
inhibitors (NNRTIs). However, HIV-associated BW loss still oc-
curs frequently in the setting of advanced HIV infection,
Switzerland it affects 5% of the Swiss HIV-infected patients.
Our goal was to evaluate the effects of rhGH therapy on BW
loss and body composition in HIV patients on highly active anti-
retroviral therapy, who presented persistent BW loss of more than
5% of their usual weight despite the treatment of possible etiolo-
gies of BW loss, nutritional intervention, and physical activity
program. We felt it would be preferable to do the study in an
ambulatory setting rather than a research center because results
would be more easily applicable to routine clinical care.
Data were presented in part at the 20th ESPEN Congress, Stockholm, 1999.
The authors thank the Foundations Asclepios and Nutrition 2000 Plus for
Correspondence to: Claude Pichard, MD, PhD, Head of Clinical Nu-
trition, Geneva University Hospital, 1211 Geneva, Switzerland. E-mail:
Nutrition 18:583–586, 2002 0899-9007/02/$22.00
©Elsevier Science Inc., 2002. Printed in the United States. All rights reserved. PII S0899-9009(02)00760-8