Relationship of peak growth hormone to cardiovascular parameters, waist circumference, lipids and glucose in HIV‐infected patients and healthy adults

Abstract

SUMMARYObjective: Relative growth hormone (GH) deficiency is highly prevalent in patients with HIV. The purpose of this study was to investigate relationships of GH to metabolic and anthropometric parameters in HIV patients and non-HIV controls.Design: Peak GH and metabolic parameters were assessed in a cross-sectional study of 191 HIV patients and 62 age and BMI-matched healthy controls.Methods: Peak GH was assessed by GHRH/arginine stimulation testing. Results:HIV patients demonstrated similar BMI, but increased waist circumference (WC) and reduced peak GH to GHRH/arginine compared with control subjects (12.4 [6.3, 24.8] vs. 21.3 [8.8, 34.5] μg/l, P=0.006, HIV vs. control). Among HIV and non-HIV groups, peak GH was inversely associated with WC (rho=−0.44, p<0.0001; rho=−0.63, p<0.0001)(HIV patients and controls, respectively), blood pressure (rho=−0.17, p=0.02; rho=−0.36, p=0.004), triglycerides (rho=−0.37, p<0.0001; rho=−0.43, p=0.001), glucose (rho=−0.34, p<0.0001; rho=−0.30, p=0.02), insulin (rho=−0.43, p<0.0001; rho=−0.60, p<0.0001) and CRP (rho=−0.29, p<0.0001; rho=−0.59, p<0.0001). Among HIV patients, the inverse association between peak GH and fasting glucose remained significant (β=−0.006mmol/l change in glucose per μg/l change in GH, p=0.004) controlling for age, gender, race, BMI, WC, protease inhibitor(PI) and nucleoside reverse transcriptase inhibitors(NRTI). Similarly, the inverse association between peak GH and triglycerides remained significant (β=−0.01mmol/l change in triglycerides per μg/l change in GH, p=0.02) controlling for age, gender, race, BMI, WC, PI and lipid-lowering medications. HIV men with peak GH<7.5μg/l demonstrated higher BMI, WC, SBP, triglycerides, glucose and CRP. Conclusions:Reduced GH secretion is independently associated with dyslipidemia and higher glucose, among HIV patients with abdominal fat accumulation.

Prevalence of obesity and cardiovascular risk in patients with HIV/AIDS in Porto Alegre, Brazil

“…HIV patients had increased WC when compared to non-HIV controls (23). Near half of our outpatients (51.3%) had CVR, according to their WC.…”

GH response to GHRH plus arginine is impaired in lipoatrophic women with human immunodeficiency virus compared with controls

“…In HIV-infected men, however, reduced GH secretion occurs more frequently in patients with lipodystrophy (6,9), while no study compared lipodystrophic with nonlipodystrophic women. Accordingly, the GH/IGF1 axis has been less well studied in HIV-infected women (3, 7) compared with men (6,7,8,9). Among females, GH secretion did not differ between HIV and control subjects (3,7), while no data are available in relatively lipoatrophic HIV-infected women.…”

“…Reduced GH secretion occurs in about one-third of HIV-infected male patients (3,4) with HIV/HAARTassociated lipodystrophy (HAL) (5). GH response to GHRH plus arginine (GHRHCArg) is impaired in HIVinfected men compared with age-and body mass index (BMI)-matched male HIV-uninfected controls (6,7,8). In HIV-infected men, however, reduced GH secretion occurs more frequently in patients with lipodystrophy (6,9), while no study compared lipodystrophic with nonlipodystrophic women.…”

“…Among females, GH secretion did not differ between HIV and control subjects (3,7), while no data are available in relatively lipoatrophic HIV-infected women. Reduced GH secretion is related to fat redistribution (3,4,6,7,8,9) and elevated free fatty acids (FFA) in men (3,4,9), but this association seems to be less pronounced or absent in women (3,7). Among HIV-infected (3,7) and HIV-uninfected subjects (10), gender differences in GH secretion and body composition effects are seen (11,12).…”

“…GH peak response to GHRHCArg test was evaluated in all the 155 subjects enrolled in the study according to different cutoff values (6,7,15,16,18). The threshold of GH peak of 7.5 mg/l was used to separate normal from impaired responses to GHRHC Arg in both the HIV-infected patients and the healthy controls as it was previously used in studies on HIVinfected subjects (6,7,8) and it is close to that of 8.0 mg/l, which is commonly used for overweight subjects (18). The parameters used to evaluate the GH response to GHRHCArg were the serum GH peak and the area under the curve (AUC).…”