Body Composition and Adipose Tissue in HIV

HIV lipodystrophy is increasingly recognized as a common and clinically significant long-term
sequelae of HIV treatment. In the HIV lipodystrophy lipohypertrophy phenotype, visceral
adipose tissue (VAT) is increased and this is associated with reduced growth hormone (GH)
secretion. Mounting evidence also links this phenotype with dyslipidemia, insulin resistance,
subclinical atherosclerosis and cardiovascular (CV) disease in patients with HIV disease. The
etiology of HIV lipodystrophy (HIVLD) with central adiposity is unclear, but this phenotype
is increasingly common with newer, less lipotoxic combination anti-retroviral therapy (cART)
use. VAT and hepatic lipid accumulation, are important health concerns for HIVLD patients.
This body composition pattern may contribute to the increased cardiovascular risk that has
been demonstrated in patients with HIV lipodystrophy. Patients with HIVLD and central
adiposity have been shown to have reduced GH secretion. Thus, a medication has been developed
to augment GH secretion. This medication is tesamorelin. GH supplementation in other clinical
settings has been shown to reduce visceral adiposity and may reduce hepatic lipid content.

Inclusion Criteria:

- HIV-infected subjects with HIV lipodystrophy (HIVLD)

- Abdominal fat accumulation defined as: Waist Circumference (WC) 102 cm for men, 88 cm
for women, except in subjects of East/South Asian ethnicity in whom this will be
defined by WC 90 cm for men and 80 cm for women.

- Weight stable for 8 weeks prior to enrollment,

- CD4 count >100 cells/mm3

- HIV RNA load <1000 copies/mL

- Fasting plasma glucose <120 mg/dL

- Stable combination anti-retroviral therapy (cART) of any regimen for ≥ 8 weeks prior
to study enrollment

Exclusion Criteria:

- Diabetes mellitus requiring medication

- History of any malignancy

- Abnormal renal or liver function

- Pregnancy or women of childbearing age who are not using an acceptable means of
contraception

- History disorder of the hypothalamic-pituitary axis due to hypophysectomy,
hypopituitarism or pituitary tumor/surgery

- Head irradiation or head trauma or adrenal insufficiency

- Systemic glucocorticoid use

- Known hypersensitivity to tesamorelin and/or mannitol