However, clinicians must decide whether the attributed benefits are clinically significant, considering the costs and potential risks of GH axis treatments. A limitation of this study is the small number of studies available of each GH axis drug class. Disorders of body fat metabolism and associated metabolic buy MK0683 alterations are common in patients infected with HIV . While the definition is not standardized, a diagnosis of HIV-associated lipodystrophy describes metabolic derangements including insulin resistance and changes in lipid metabolism, which result in lipoatrophy (peripheral adipose wasting) and lipohypertrophy (visceral adipose accumulation)
. The pathogenesis of HIV-associated lipodystrophy is multifactorial and includes genetic predisposition, effects of antiretroviral agents, HIV infection itself, and other host factors . Highly active antiretroviral therapy (HAART) is comprised of potent antiretroviral agents, which have dramatically improved clinical outcomes in patients with HIV infection. Unfortunately, HAART is often associated with the
onset, or exacerbation, LDK378 cost of HIV-associated lipodystrophy . The prevalence of HIV-associated lipodystrophy is 4% in untreated patients and 13–40% in patients on HAART . The associated fat redistribution syndrome can lead to negative social, psychological and medical consequences
. Cosmetic changes in body shape may result in decreased compliance with HAART, which can result in increased viral replication and associated morbidities and mortality . The metabolic derangements in HIV-associated lipodystrophy are difficult to reverse. A number of treatments for this condition have been explored, including metformin, thiazolidinediones (TZDs), testosterone and growth hormone (GH) axis drugs. Metformin has been shown to reduce visceral adipose tissue (VAT) mass but accelerates peripheral adipose tissue loss. TZDs and testosterone are not effective in reducing triclocarban VAT. However, some studies have shown that GH axis drugs can both decrease VAT and help to maintain or improve peripheral adipose tissue mass . Although the underlying mechanism for the development of HIV-associated lipodystrophy and related disorders such as metabolic syndrome is not fully understood, evidence suggests that neurohormonal dysregulation plays a role in causing these debilitating conditions [6–8]. GH is a polypeptide hormone secreted episodically by the adenohypophysis that affects protein, carbohydrate and lipid metabolism. There is also evidence that it plays a role in skeletal and visceral growth. Specifically, GH affects the metabolism of fats by causing cells to switch from using carbohydrates for fuel to burning fats for energy.