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Effects of Growth Hormone Releasing Hormone in HIV

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Steven K. Grinspoon, MD, Massachusetts General Hospital
ClinicalTrials.gov Identifier:
NCT01263717
First received: December 16, 2010
Last updated: October 10, 2014
Last verified: October 2014
History of Changes
December 16, 2010
October 10, 2014
December 2010
February 2014   (Final data collection date for primary outcome measure)
  • Liver Fat [ Time Frame: 6 months ]
    Hepatic fat as measured by magnetic resonance (MR) spectroscopy, and expressed by normalizing lipid to water and expressing as a percent (lipid-to-water percent).
  • Visceral Adipose Tissue [ Time Frame: 6 months ]
    Change in visceral adipose tissue area as measured by single-slice computed tomography (CT) scan at the L4 vertebra.
  • Liver Fat [ Time Frame: 6 months ]
    Hepatic fat as measured by magnetic resonance (MR) spectroscopy.
  • Visceral Adipose Tissue [ Time Frame: 6 months ]
    Change in visceral adipose tissue area as measured by single-slice computed tomography (CT) scan at the L4 vertebra.
Complete list of historical versions of study NCT01263717 on ClinicalTrials.gov Archive Site
  • Intramyocellular Lipid [ Time Frame: 6 months ]
    Intramyocellular lipid (IMCL) as measured by magnetic resonance (MR) spectroscopy of the calf. Soleus IMCL normalized to creatinine (IMCL/Cr based on areas determined by spectroscopy) was measured. The change over 6 months is reported.
  • Endogenous Growth Hormone Secretion [ Time Frame: 6 months ]
    Endogenous growth hormone (GH) concentrations measured by overnight frequent blood sampling every 20 minutes. Mean overnight GH concentration is given.
  • Insulin Sensitivity [ Time Frame: 6 months ]
    In a subgroup of 1/2 of the subjects, euglycemic hyperinsulinemic clamp will be performed to assess insulin-stimulated glucose uptake. Insulin stimulated glucose uptake (M) calculated using the method of DeFronzo is shown.
  • HbA1c [ Time Frame: 6 months ]
    Hemoglobin A1c.
  • Insulin Like Growth Factor 1 (IGF-I) [ Time Frame: 6 months ]
    Insulin Like Growth Factor 1 (IGF-I).
  • Lipid Panel [ Time Frame: 6 months ]
    Fasting lipids. Triglyceride value is given.
  • Carotid Intimal Medial Thickness (cIMT) [ Time Frame: 6 months ]
    Carotid Intimal Medial Thickness (cIMT).
  • Glucose Tolerance [ Time Frame: 6 months ]
    Glucose tolerance as measured by standard oral glucose tolerance test. 2-hour glucose is given.
  • Adiponectin [ Time Frame: 6 months ]
    adiponectin.
  • Hemostatic Markers [ Time Frame: 6 months ]
    Tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) measured in serum.
  • Intramyocellular Lipid [ Time Frame: 6 months ]
    Intramyocellular lipid as measured by magnetic resonance (MR) spectroscopy of the calf.
  • Endogenous Growth Hormone Secretion [ Time Frame: 6 months ]
    Endogenous growth hormone concentrations will be measured by overnight freqent blood sampling, and a deconvolution algorithm will be used to characterize the pulsatility of secretion.
  • Insulin Sensitivity [ Time Frame: 6 months ]
    In a subgroup of 1/2 of the subjects, euglycemic hyperinsulinemic clamp will be performed to assess insulin-stimulated glucose uptake.
  • HbA1c [ Time Frame: 6 months ]
    Hemoglobin A1c.
  • Insulin Like Growth Factor 1 (IGF-I) [ Time Frame: 6 months ]
    Insulin Like Growth Factor 1 (IGF-I).
  • Lipid panel [ Time Frame: 6 months ]
    Fasting lipids as well as lipoprotein (a), Apoprotein B, Apoprotein A1, LDL particle size, LP-PLA2.
  • Carotid Intimal Medial Thickness (cIMT) [ Time Frame: 6 months ]
    Carotid Intimal Medial Thickness (cIMT).
  • Glucose Tolerance [ Time Frame: 6 months ]
    Glucose tolerance as measured by standard oral glucose tolerance test.
  • Adiponectin [ Time Frame: 6 months ]
    adiponectin.
  • Hemostatic Markers [ Time Frame: 6 months ]
    Tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) measured in serum.
Not Provided
Not Provided
 
Effects of Growth Hormone Releasing Hormone in HIV
Effects of Growth Hormone Releasing Hormone on Fat Redistribution, Cardiovascular Indices, and Growth Hormone Secretion in HIV Lipodystrophy
HIV-infection and its treatment are often associated with an increase in belly fat, as well as abnormal cholesterol and problems metabolizing sugar. People with HIV infection and increased belly fat often have decreased growth hormone (GH) levels. Low GH levels may contribute independently to increased belly fat and to increased cardiovascular risk through effects on sugar metabolism, inflammation, and other mechanisms. Tesamorelin, a growth hormone releasing hormone (GHRH) analogue, has been shown to to reduce belly fat in patients with HIV-associated abdominal fat accumulation. However, the effects of tesamorelin on fat accumulation in the liver and muscle, sugar metabolism, and cardiovascular health are not yet known. The current study is designed to determine the effects of tesamorelin treatment on fat accumulation in the muscle and liver, insulin sensitivity and sugar metabolism, and markers of cardiovascular health including blood vessel thickness (carotid intima media thickness [cIMT]) and markers of inflammation in the body. The investigators hypothesize that tesamorelin will decrease fat accumulation in the liver and muscle and will decrease markers of inflammation, with either neutral or beneficial effects on glucose metabolism.
Not Provided
Interventional
Not Provided
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
  • HIV
  • HIV Lipodystrophy
  • Drug: tesamorelin
    Tesamorelin (growth hormone releasing hormone) 2mg daily given by subcutaneous injection x 6 months during randomized phase, followed by 6 months of open-label tesamorelin at same dose
    Other Name: Egrifta, growth hormone releasing hormone, TH9507
  • Drug: placebo
    Placebo 2mg daily given by subcutaneous injection for the first 6 months of the study, followed by an open-label phase of 6 months of tesamorelin (growth hormone releasing hormone) treatment, 2mg daily given by subcutaneous injection
  • Experimental: Tesamorelin
    Tesamorelin (growth hormone releasing hormone) 2mg daily given subcutaneously x 6 months during randomized phase, followed by 6 months of open-label tesamorelin at same dose
    Intervention: Drug: tesamorelin
  • Placebo Comparator: Placebo (inactive injection)
    Placebo 2mg daily given subcutaneously for the first 6 months of the study, followed by 6 months of tesamorelin (growth hormone releasing hormone) 2mg daily during an open label phase
    Intervention: Drug: placebo
Stanley TL, Feldpausch MN, Oh J, Branch KL, Lee H, Torriani M, Grinspoon SK. Effect of tesamorelin on visceral fat and liver fat in HIV-infected patients with abdominal fat accumulation: a randomized clinical trial. JAMA. 2014 Jul 23-30;312(4):380-9. doi: 10.1001/jama.2014.8334.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
54
February 2014
February 2014   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  1. Men and women age 18-65
  2. Previously diagnosed HIV infection
  3. Stable antiviral regimen for at least 12 weeks prior to enrollment
  4. WC>95 cm and WHR>0.94 for male, WC>94 cm and WHR>0.88 for female occurring in the context of treatment for HIV disease
  5. Subjective evidence of at least one of the following recent changes, occurring during the treatment of HIV disease: increased abdominal girth, relative loss of fat in the extremities, or relative loss of fat in the face
  6. For female subjects 40yo or older, negative mammogram within one year of baseline

Exclusion Criteria:

  1. Use of anti-diabetic agents, Megace, testosterone or any steroid use within 6 months of the study. Stable use of testosterone (> 6 mos) at dose equivalent to 200 mg IM q 2 weeks or < 10g/day to skin will be permitted.
  2. Use of GH or GHRH within the past 6 months
  3. Change in lipid lowering or antihypertensive regimen within 3 months of screening
  4. Fasting blood sugar > 126 mg/dL, SGOT > 2.5 times ULN, HgB < 12.0 g/dL, creatinine > 1.4 mg/dL, CD4 count < 200
  5. Severe chronic illness or active malignancy or history of pituitary malignancy or history of colon cancer
  6. For men, history of prostate cancer or evidence of prostate malignancy by PSA > 5 ng/mL
  7. Prior history of hypopituitarism, head irradiation or any other condition known to affect the GH axis
  8. For women, positive urine hCG
  9. Oral contraceptives, depo provera or combined progesterone-estrogen injections, transdermal contraceptive patches, estrogen or progestin coated IUD's within 6 months of the study.
  10. Routine MRI exclusion criteria such as the presence of a pacemaker or cerebral aneurysm clip.
Sexes Eligible for Study: All
18 Years to 65 Years   (Adult)
No
Contact information is only displayed when the study is recruiting subjects
United States
 
 
NCT01263717
2007p-000638
Yes
Not Provided
Not Provided
Steven K. Grinspoon, MD, Massachusetts General Hospital
Massachusetts General Hospital
Not Provided
Principal Investigator: Steven Grinspoon, MD Massachusetts General Hospital
Massachusetts General Hospital
October 2014

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP