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Bt Paul - One of the best experts on this subject based on the ideXlab platform.

  • growth hormone axis treatments for HIV Associated Lipodystrophy a systematic review of placebo controlled trials
    Hiv Medicine, 2011
    Co-Authors: T Sivakumar, Oren J. Mechanic, Da Fehmie, Bt Paul
    Abstract:

    Background HIV-Associated Lipodystrophy is a disorder of fat metabolism that occurs in patients with HIV infection. It can cause metabolic derangements and negative self-perceptions of body image, and result in noncompliance with highly active antiretroviral therapy (HAART). Growth hormone (GH) axis drugs have been evaluated for treatment of this disorder, but no systematic review has been conducted previously. Objectives The aim of the review was to compare the effects of GH axis drugs vs. placebo in changing visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and lean body mass (LBM) in patients with HIV-Associated Lipodystrophy. Search methods We searched MEDLINE (1996–2009), CENTRAL (Issue 4, 2009), Web of Science, Summons, Google Scholar, the Food and Drug Administration (FDA) website, and Clinicaltrials.gov from 13 October 2009 to 7 June 2010. We excluded newspaper articles and book reviews from the Summons search; this was the only search limitation applied. We also manually reviewed references of included articles. Selection criteria Inclusion criteria were as follows: randomized placebo-controlled trial (RCT); study participants with HIV-Associated Lipodystrophy; intervention consisting of GH, growth hormone releasing hormone (GHRH), tesamorelin or insulin-like growth factor-1 (IGF-1); study including at least one primary outcome of interest: change in VAT, SAT or LBM. Data collection and analysis Two independent reviewers extracted data and assessed study quality using a standardized form. The authors of one study were contacted for missing information. The main effect was calculated as a summary of the mean differences in VAT, SAT and LBM between the intervention and placebo groups in the included studies. Subgroup analyses were performed to assess different GH axis drug classes. Results Ten RCTs including 1511 patients were included in the review. All had a low risk of bias and passed the test of heterogeneity for each primary outcome. Compared with placebo, GH axis treatments decreased VAT [weighted mean difference (WMD) –25.20 cm2; 95% confidence interval (CI) –32.18 to –18.22 cm2; P<0.001] and increased LBM (WMD 1.31 kg; 95% CI 1.00 to 1.61 kg; P<0.001], but had no significant effect on SAT mass (WMD –3.94 cm2; 95% CI –10.88 to 3.00 cm2; P=0.27]. Subgroup analyses showed that GH had the most significant effects on VAT and SAT, but none on LBM. The drugs were well tolerated but statistically significant side effects included arthralgias and oedema. Conclusions Our review indicates that, based on the findings of the 10 included studies, GH axis treatments are effective in reducing VAT and increasing LBM in patients with HIV-Associated Lipodystrophy. 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.

  • Growth hormone axis treatments for HIV-Associated Lipodystrophy: a systematic review of placebo-controlled trials
    HIV medicine, 2011
    Co-Authors: T Sivakumar, Oren J. Mechanic, Da Fehmie, Bt Paul
    Abstract:

    Background HIV-Associated Lipodystrophy is a disorder of fat metabolism that occurs in patients with HIV infection. It can cause metabolic derangements and negative self-perceptions of body image, and result in noncompliance with highly active antiretroviral therapy (HAART). Growth hormone (GH) axis drugs have been evaluated for treatment of this disorder, but no systematic review has been conducted previously. Objectives The aim of the review was to compare the effects of GH axis drugs vs. placebo in changing visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and lean body mass (LBM) in patients with HIV-Associated Lipodystrophy. Search methods We searched MEDLINE (1996–2009), CENTRAL (Issue 4, 2009), Web of Science, Summons, Google Scholar, the Food and Drug Administration (FDA) website, and Clinicaltrials.gov from 13 October 2009 to 7 June 2010. We excluded newspaper articles and book reviews from the Summons search; this was the only search limitation applied. We also manually reviewed references of included articles. Selection criteria Inclusion criteria were as follows: randomized placebo-controlled trial (RCT); study participants with HIV-Associated Lipodystrophy; intervention consisting of GH, growth hormone releasing hormone (GHRH), tesamorelin or insulin-like growth factor-1 (IGF-1); study including at least one primary outcome of interest: change in VAT, SAT or LBM. Data collection and analysis Two independent reviewers extracted data and assessed study quality using a standardized form. The authors of one study were contacted for missing information. The main effect was calculated as a summary of the mean differences in VAT, SAT and LBM between the intervention and placebo groups in the included studies. Subgroup analyses were performed to assess different GH axis drug classes. Results Ten RCTs including 1511 patients were included in the review. All had a low risk of bias and passed the test of heterogeneity for each primary outcome. Compared with placebo, GH axis treatments decreased VAT [weighted mean difference (WMD) –25.20 cm2; 95% confidence interval (CI) –32.18 to –18.22 cm2; P

T Sivakumar - One of the best experts on this subject based on the ideXlab platform.

  • growth hormone axis treatments for HIV Associated Lipodystrophy a systematic review of placebo controlled trials
    Hiv Medicine, 2011
    Co-Authors: T Sivakumar, Oren J. Mechanic, Da Fehmie, Bt Paul
    Abstract:

    Background HIV-Associated Lipodystrophy is a disorder of fat metabolism that occurs in patients with HIV infection. It can cause metabolic derangements and negative self-perceptions of body image, and result in noncompliance with highly active antiretroviral therapy (HAART). Growth hormone (GH) axis drugs have been evaluated for treatment of this disorder, but no systematic review has been conducted previously. Objectives The aim of the review was to compare the effects of GH axis drugs vs. placebo in changing visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and lean body mass (LBM) in patients with HIV-Associated Lipodystrophy. Search methods We searched MEDLINE (1996–2009), CENTRAL (Issue 4, 2009), Web of Science, Summons, Google Scholar, the Food and Drug Administration (FDA) website, and Clinicaltrials.gov from 13 October 2009 to 7 June 2010. We excluded newspaper articles and book reviews from the Summons search; this was the only search limitation applied. We also manually reviewed references of included articles. Selection criteria Inclusion criteria were as follows: randomized placebo-controlled trial (RCT); study participants with HIV-Associated Lipodystrophy; intervention consisting of GH, growth hormone releasing hormone (GHRH), tesamorelin or insulin-like growth factor-1 (IGF-1); study including at least one primary outcome of interest: change in VAT, SAT or LBM. Data collection and analysis Two independent reviewers extracted data and assessed study quality using a standardized form. The authors of one study were contacted for missing information. The main effect was calculated as a summary of the mean differences in VAT, SAT and LBM between the intervention and placebo groups in the included studies. Subgroup analyses were performed to assess different GH axis drug classes. Results Ten RCTs including 1511 patients were included in the review. All had a low risk of bias and passed the test of heterogeneity for each primary outcome. Compared with placebo, GH axis treatments decreased VAT [weighted mean difference (WMD) –25.20 cm2; 95% confidence interval (CI) –32.18 to –18.22 cm2; P<0.001] and increased LBM (WMD 1.31 kg; 95% CI 1.00 to 1.61 kg; P<0.001], but had no significant effect on SAT mass (WMD –3.94 cm2; 95% CI –10.88 to 3.00 cm2; P=0.27]. Subgroup analyses showed that GH had the most significant effects on VAT and SAT, but none on LBM. The drugs were well tolerated but statistically significant side effects included arthralgias and oedema. Conclusions Our review indicates that, based on the findings of the 10 included studies, GH axis treatments are effective in reducing VAT and increasing LBM in patients with HIV-Associated Lipodystrophy. 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.

  • Growth hormone axis treatments for HIV-Associated Lipodystrophy: a systematic review of placebo-controlled trials
    HIV medicine, 2011
    Co-Authors: T Sivakumar, Oren J. Mechanic, Da Fehmie, Bt Paul
    Abstract:

    Background HIV-Associated Lipodystrophy is a disorder of fat metabolism that occurs in patients with HIV infection. It can cause metabolic derangements and negative self-perceptions of body image, and result in noncompliance with highly active antiretroviral therapy (HAART). Growth hormone (GH) axis drugs have been evaluated for treatment of this disorder, but no systematic review has been conducted previously. Objectives The aim of the review was to compare the effects of GH axis drugs vs. placebo in changing visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and lean body mass (LBM) in patients with HIV-Associated Lipodystrophy. Search methods We searched MEDLINE (1996–2009), CENTRAL (Issue 4, 2009), Web of Science, Summons, Google Scholar, the Food and Drug Administration (FDA) website, and Clinicaltrials.gov from 13 October 2009 to 7 June 2010. We excluded newspaper articles and book reviews from the Summons search; this was the only search limitation applied. We also manually reviewed references of included articles. Selection criteria Inclusion criteria were as follows: randomized placebo-controlled trial (RCT); study participants with HIV-Associated Lipodystrophy; intervention consisting of GH, growth hormone releasing hormone (GHRH), tesamorelin or insulin-like growth factor-1 (IGF-1); study including at least one primary outcome of interest: change in VAT, SAT or LBM. Data collection and analysis Two independent reviewers extracted data and assessed study quality using a standardized form. The authors of one study were contacted for missing information. The main effect was calculated as a summary of the mean differences in VAT, SAT and LBM between the intervention and placebo groups in the included studies. Subgroup analyses were performed to assess different GH axis drug classes. Results Ten RCTs including 1511 patients were included in the review. All had a low risk of bias and passed the test of heterogeneity for each primary outcome. Compared with placebo, GH axis treatments decreased VAT [weighted mean difference (WMD) –25.20 cm2; 95% confidence interval (CI) –32.18 to –18.22 cm2; P

Jacqueline L. Olin - One of the best experts on this subject based on the ideXlab platform.

  • tesamorelin a growth hormone releasing factor analogue for HIV Associated Lipodystrophy
    Annals of Pharmacotherapy, 2012
    Co-Authors: Linda M. Spooner, Jacqueline L. Olin
    Abstract:

    Objective:To evaluate the efficacy and safety of tesamorelin, a growth hormone releasing factor analogue approved by the Food and Drug Administration in November 2010 for the treatment of Lipodystrophy Associated with HIV infection.Data Sources:Literature was obtained through MEDLINE (1948-November 2011) and International Pharmaceutical Abstracts (1970-october 2011) using the search terms tesamorelin, TH9507, growth hormone releasing factor, and HIV-Associated Lipodystrophy syndrome. Additional publications were obtained through review of references within primary literature publications as well as pertinent Web sites.Study Selection and Data Extraction:All articles published in English identified from the data sources were evaluated and all pertinent information was included. All studies relevant to the evaluation of efficacy and safety of tesamorelin in the management of HIV-Associated Lipodystrophy were included, with a focus on trials completed in humans.Data Synthesis:In 2 Phase 3 clinical trials and...

  • Tesamorelin: A Growth Hormone–Releasing Factor Analogue for HIV-Associated Lipodystrophy
    The Annals of pharmacotherapy, 2012
    Co-Authors: Linda M. Spooner, Jacqueline L. Olin
    Abstract:

    Objective:To evaluate the efficacy and safety of tesamorelin, a growth hormone releasing factor analogue approved by the Food and Drug Administration in November 2010 for the treatment of Lipodystrophy Associated with HIV infection.Data Sources:Literature was obtained through MEDLINE (1948-November 2011) and International Pharmaceutical Abstracts (1970-october 2011) using the search terms tesamorelin, TH9507, growth hormone releasing factor, and HIV-Associated Lipodystrophy syndrome. Additional publications were obtained through review of references within primary literature publications as well as pertinent Web sites.Study Selection and Data Extraction:All articles published in English identified from the data sources were evaluated and all pertinent information was included. All studies relevant to the evaluation of efficacy and safety of tesamorelin in the management of HIV-Associated Lipodystrophy were included, with a focus on trials completed in humans.Data Synthesis:In 2 Phase 3 clinical trials and...

Marie C. Gelato - One of the best experts on this subject based on the ideXlab platform.

  • Chronic loss of subcutaneous adipose tissue in HIV-Associated Lipodystrophy may not be Associated with accelerated apoptosis.
    Journal of acquired immune deficiency syndromes (1999), 2005
    Co-Authors: Dennis C. Mynarcik, Lin-xiang Wei, Eugene Komaroff, Robert L. Ferris, Margaret A. Mcnurlan, Marie C. Gelato
    Abstract:

    HIV-Associated Lipodystrophy (HIV-LD) is characterized by a loss of adipose tissue from the subcutaneous compartment. Previously reported data suggested that this loss of adipose tissue was the result of an increased rate of apoptosis in subcutaneous adipose tissue (SAT). The present study examined the rate of apoptosis in SAT with a sensitive ligase-mediated polymerase chain reaction technique to amplify DNA ladders. Individuals with HIV-LD were compared with HIV-infected subjects without LD and subjects without HIV disease. Although apoptosis was observed in subjects with HIV-LD, there was no difference in the incidence of individuals with apoptosis among those with HIV-LD (10 of 22 subjects), those with HIV but no LD (13 of 25 subjects), and those without HIV disease (13 of 27 subjects). These data suggest that HIV-related chronic loss of SAT may not always be Associated with increased frequency of adipocyte apoptosis.

  • Loss of subcutaneous adipose tissue in HIV-Associated Lipodystrophy is not due to accelerated apoptosis.
    Journal of acquired immune deficiency syndromes (1999), 2005
    Co-Authors: Dennis C. Mynarcik, Lin-xiang Wei, Eugene Komaroff, Robert L. Ferris, Margaret A. Mcnurlan, Marie C. Gelato
    Abstract:

    HIV-Associated Lipodystrophy is characterized by a loss of adipose tissue from the subcutaneous compartment. Previously reported data suggested that this loss of adipose tissue was the result of an increased rate of apoptosis in subcutaneous adipose tissue. The present study examined the rate of apoptosis in subcutaneous adipose tissue with a sensitive ligase-mediated polymerase chain reaction technique to amplify DNA ladders. Individuals with HIV Lipodystrophy were compared with HIV-infected subjects without Lipodystrophy and subjects without HIV disease. Although apoptosis was observed in subjects with HIV Lipodystrophy, there was no difference in the frequency of individuals with apoptosis among those with HIV Lipodystrophy (10/22), those with HIV but no Lipodystrophy (13/25), and subjects without HIV disease (13/27).

Nicholas I. Paton - One of the best experts on this subject based on the ideXlab platform.

  • comparison of dual energy x ray absorptiometry machines for measuring fat distribution changes of HIV Associated Lipodystrophy
    Antiviral Therapy, 2004
    Co-Authors: Yong Yang, W. D. Zhu, Nicholas I. Paton
    Abstract:

    Background: Dual-energy X-ray absorptiometry (DXA) is regarded as a useful objective method for diagnosis of HIV-Associated Lipodystrophy (LD). Objective: To determine whether the use of different DXA machines may affect the diagnosis of LD. Methods: Body composition in 24 HIV-infected patients, 12 of whom had clinically diagnosed LD, was measured on two DXA machines (Lunar and Hologic). Results: Hologic gave significantly higher values than Lunar DXA for total body fat percent (22.9 vs 20.5%, P<0.001), arm fat percent (27.9 vs 14.5%, P<0.001) and leg fat percent (23.4 vs 17.5%, P<0.001), and significantly lower values than Lunar for trunk fat percent (22.3 vs 24.7%, P<0.001) and trunk-to-limb fat percent ratio (0.89 vs 1.62, P<0.001). When measured by Lunar, patients with LD had significantly lower leg fat percent (13.5 vs 21.6%, P=0.04) and higher trunk-to-limb fat percent ratio (1.85 vs 1.38; P=0.012) than those without LD. When measured by Hologic, patients with LD had values of leg fat percent (20.1 vs 26.8%, P=0.11) and trunk-to-limb fat percent ratio (0.95 vs 0.85, P=0.43) that did not differ significantly from those without LD. There was a significant difference in the contribution to a composite LD score between Lunar and Hologic measurements. Conclusion: DXA machines from different manufacturers give major differences in measurements of body fat content and distribution, and this may affect the ability to distinguish patients with LD from those without LD. Further standardization of DXA technology is needed before widespread application in the clinical diagnosis of LD.

  • Comparison of dual-energy X-ray absorptiometry machines for measuring fat distribution changes of HIV-Associated Lipodystrophy.
    Antiviral therapy, 2004
    Co-Authors: Yong Yang, W. D. Zhu, Nicholas I. Paton
    Abstract:

    Background: Dual-energy X-ray absorptiometry (DXA) is regarded as a useful objective method for diagnosis of HIV-Associated Lipodystrophy (LD). Objective: To determine whether the use of different DXA machines may affect the diagnosis of LD. Methods: Body composition in 24 HIV-infected patients, 12 of whom had clinically diagnosed LD, was measured on two DXA machines (Lunar and Hologic). Results: Hologic gave significantly higher values than Lunar DXA for total body fat percent (22.9 vs 20.5%, P