Impaired growth hormone secretion correlates with visceral adiposity in highly active antiretroviral treated HIV-infected adolescents.

Abstract

HIV-infected adults with lipodystrophy, characterized by excess accumulation of intra-abdominal adipose tissue (IAT), showed impaired growth hormone (GH) secretion. Data are lacking in paediatric lipodystrophy with the same features. Twenty-five pubertal HIV-infected children were assessed for GH response (GH-AUC(0-120 min)) to arginine + GHRH testing, insulin-like growth factor-1 (IGF-1), IGF binding protein 3 (IGFBP-3), insulin, glucose, cholesterol, triglycerides, free fatty acids and nitric oxide levels. Body composition and IAT content were evaluated by dual-energy x-ray-absorptiometry and magnetic resonance imaging. An excess accumulation of IAT was defined as a value > 41 cm2. Differences between children with (V+) and without (V-) excess IAT were assessed by non-parametric tests and multivariate analysis. RESULTS Ten V+ (mean IAT, 82.5 cm2) and 15 V- (mean IAT, 26.8 cm2) were identified; they were similar for age (13.8 versus 14.8 years), body mass index (20.2 versus 19.5 kg/m2), male : female ratio (3/7 versus 8/7), months on highly active antiretroviral therapy (54.5 versus 55 months). V+ showed lower GH-AUC(0-120 min) (16.4 versus 31.6 microg x h/l; P = 0.002), lower IGF-1 concentrations (384 versus 515 ng/ml; P = 0.03) and higher insulin levels (17.8 versus 10.5 microIU/ml; P = 0.01) than V-. V+, as compared to V-, showed lower lean mass (total, P = 0.025; arms, P = 0.024; legs, P = 0.008) and higher fat mass (total, P = 0.0038; arms, P = 0.028; trunk, P < 0.0001). Lipid profile and glucose, IGFBP-3, nitric oxide and free fatty acids levels were similar in the two groups. GH-AUC(0-120 min) correlated negatively with IAT content and insulin levels. Impaired GH secretion is detectable in pubertal children with increased visceral adiposity and hyperinsulinemia. GH therapy should be considered in lipodystrophic HIV-infected children with excess IAT.