Gender differences in GH response to GHRH+ARG in lipodystrophic patients with HIV: a key role for body fat distribution

Abstract

Objective: Gender influence on GH secretion in human immunodeficiency virus (HIV)-infected patients is poorly known. Design and methods: To determine the effect of gender, we compared GH response to GH-releasing hormone plus arginine (GHRHCArg), and body composition in 103 men and 97 women with HIV and lipodystrophy. The main outcomes were IGF1, basal GH, GH peak and area under the curve (AUC) after GHRHCArg, body composition, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). Results: Men had lower GH peak and AUC than women (P!0.001). Of the study population, 21% of women and 37% of men had biochemical GH deficiency (GHD; GH peak !7.5 mg/l). VAT-to-SAT ratio was higher in men than in women with GHD (P!0.05). Unlike women, VAT, SAT, and trunk fat were greater in men with GHD than in men without GHD. IGF1 was significantly lower in women with GHD than in women without GHD, but not in men. At univariate analysis, BMI, trunk fat mass, VAT, and total adipose tissue were associated with GH peak and AUC in both sexes (P!0.05). BMI was the most significant predictive factor of GH peak, and AUC at multiregression analysis. Overall, abdominal fat had a less pronounced effect on GH in females than in males.Conclusions: These data demonstrate that GH response to GHRHCArg is significantly lower in HIV-infected males than females, resulting in a higher percentage of GHD in men. Adipose tissue distribution more than fat mass per se seems to account for GH gender differences and for the alteration of GH-IGF1 status in these patients.

Increased chance of metabolic syndrome in women living with HIV/AIDS and lipodystrophic syndrome

“…A principal divergência diz respeito ao acúmulo de gordura no tronco, caracterizada pela obesidade abdominal, sendo um componente obrigatório na definição da IDF, com valores limítrofes menores do que os estabelecidos pelo NCEP-ATP III e AHA/NHLBI, salientando a importância de constituir medidas específicas por etnias. 12 Estudos com resultados conflitantes mostram os efeitos da SL sobre a SM em pacientes infectados pelo HIV, 11,[14][15][16][17][18][19][20][21] do impacto que as diferenças sexuais promovem, 3,4,5 ou mesmo se homens e mulheres deveriam se submeter a formas similares de TARV. 6 Dada a esta controvérsia, o objetivo deste estudo foi avaliar os efeitos da SL sobre os parâ-metros utilizados para diagnóstico da SM para cada sexo, em pacientes que vivem com HIV/aids em uso da TARV.…”

“…2 Esta alteração lipodistrófica manifesta-se de maneira distinta entre os sexos. [3][4][5][6] Enquanto nos homens é caracterizada essencialmente pela redução da gordura periférica (Lipoatrofia) em membros, glúteos e na face, nas mulheres a tendência é de maior acúmulo (Lipohipertrofia) na região do tronco, 3,5 acarretando efeitos metabólicos mais pronunciados no sexo feminino. 7 Dislipidemias e alterações no metabolismo da glicose também são observadas nos pacientes com SL, 2,8,9,10 aumentando o risco do desenvolvimento de síndrome metabóli-ca (SM), 11 condição que eleva sobremaneira a morbidade do paciente HIV positivo.…”

Serum Lipid Profile and Transaminases Levels in Hiv Patients on Haart With Adipose Tissue Alterations

“…[10] In our study we found BH in the female patients only and; limb and facial lipoatrophy with central obesity mainly in male ATA patients. This gender difference in ATA presentation might be due to hormones [11,12] along with differences in drug transport and metabolizing enzymes. [13] The HIV-associated ATA was first described in 1998, shortly after the introduction of PIs.…”

Pituitary growth hormone (GH) secretion is partially rescued in HIV-infected patients with GH deficiency (GHD) compared to hypopituitary patients

“…releasing hormone (GHRH) plus Arginine (Arg) (GHRH + Arg) test is, in fact, higher than in healthy controls [2][3][4][5]. Gender [6] and adipose tissue redistribution, typical of patients treated with Highly Active Antiretroviral Therapy (HAART), called HIV-associated lipodystrophy syndrome [1] both contribute to determine the impairment of GH secretion in these patients.…”

“…Furthermore, visceral fat seems to be a predictor of overnight GH levels [14]. However, GHD in HIV-infected patients is not thoroughly justified by the effect of visceral adiposity [2,4,5], which otherwise accounts for gender differences in GH secretion [6]. Moreover, it is not easy to define whether the GHD or the increase in visceral adiposity came first, because the increase in visceral fat disturbs the GH secretion [11,12], but it is also a consequence of GHD [15][16][17].…”