Growth hormone exerts potent anabolic effects in an adolescent with human immunodeficiency virus wasting

Growth hormone improves protein catabolism and growth in prepubertal children with HIV infection

INTRODUCTION

Poor linear growth and weight loss are well documented in children with human immunodeficiency virus (HIV) infection and past studies in adults and children have reported that loss of lean tissue mass (LTM) associated with accelerated rates of protein catabolism. We undertook this study to test the hypothesis that human recombinant GH would improve linear height in HIV-infected children. Our second goal was to determine if GH could reverse protein catabolism in HIV-infected children.

METHODS

We studied six HIV-infected children (mean age 9.2 years, Tanner stage I, CD4 counts 110 000--292 000, two girls, four boys). Measures of protein turnover were conducted using the stable isotope 1-[(13)C] leucine. Body composition was measured by dual X-ray absorptiometry (DXA) scan for determination of LTM. Viral burden and IGF-1 levels were measured. Studies were conducted at baseline and 6 months.

RESULTS

The baseline growth velocity of these children was only 3.9 cm/year. After 6 months of GH, growth velocity increased to 7.9 cm/year. Protein catabolism, represented as leucine rate of appearance (Ra) in the fasted state, was high at baseline, but decreased significantly after 6 months of GH therapy. Lean tissue mass significantly improved in all subjects. Viral burden did not increase significantly in any subject during GH therapy.

CONCLUSION

These results suggest that GH improves height and weight and reduces protein catabolism in HIV-infected children without negative effect on viral burden.

Growth hormone improves clinical status in prepubertal children with cystic fibrosis: results of a randomized controlled trial

OBJECTIVES

We conducted a 1-year randomized controlled trial to test the hypothesis that growth hormone (GH) improves the clinical status of children with cystic fibrosis.

STUDY DESIGN

Nineteen prepubertal children were randomized to control (NonTX, n = 9) or to daily injections of GH (0.3 mg/kg/wk) (GHTX, n = 10) for 1 year. Every 3 months height, weight, and lean tissue mass were measured. Caloric intake, resting energy expenditure, pulmonary function, and respiratory muscle strength were measured every 6 months, as were total number of hospitalizations and courses of outpatient intravenous antibiotics.

RESULTS

The GHTX group had significantly greater height, height velocity (NonTX = 3.8 +/- 1.4 cm/y, GHTX = 8.1 +/- 2.4 cm/y; P =.002), weight, weight velocity (NonTX = 2.1 +/- 0.9 kg/y, GHTX = 4.5 +/- 1.1 kg/y; P =.004), and change in lean tissue mass (NonTX = 2.1 +/- 1.6 kg, GHTX = 4.7 +/- 1.7 kg; P =.01) analyzed by the Student t test. The GHTX group had significant improvement in delta forced vital capacity compared with the year before study, and respiratory muscle strength improved. The number of hospitalizations and outpatient intravenous antibiotic courses significantly decreased in the GHTX group but did not change in the NonTX group. No subject had development of cystic fibrosis-related diabetes.

CONCLUSIONS

Results of the first randomized controlled trial of GH treatment in cystic fibrosis indicate that GH improves growth and clinical status.

Effect of protease inhibitors combined with standard antiretroviral therapy on linear growth and weight gain in human immunodeficiency virus type 1-infected children

Children with HIV-1 infection and poor growth have a significant increase in the risk of death. We studied the effects of protease inhibitors on the height and weight of 27 HIV-1-infected children and found that in our small pilot study, protease inhibitor therapy had a positive effect on the heights of HIV-1-infected children. Accelerated height velocity was sustained for at least 18 to 20 months.