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There is currently no treatment for non-alcoholic fatty liver disease (NAFLD) in HIV patients, but the results of this research could eventually lead to a first-in-class therapy for this serious condition.
The research was supported by and conducted in part by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Study drug was supplied by Theratechnologies, Inc.
The emergence of antiretroviral therapy (ART) has revolutionised the care and management of HIV. However, people with HIV who receive these life-saving treatments often develop deposits of visceral fat, which surrounds internal organs in the abdomen, as well as other deposits of "ectopic" fat, which is stored in organs or muscle instead of fatty tissue.
Visceral fat increases the risk of cardiovascular disease, type 2 diabetes, and other conditions. Ectopic fat also accumulates in the liver, resulting in NAFLD, reported the study published in the journal 'The Lancet HIV'.
Estimates suggest that 15 to 40 per cent of HIV patients may have NAFLD. Left untreated, NAFLD can progress to a condition called nonalcoholic steatohepatitis (NASH), resulting in inflammation and damaged liver cells.
This harm can ultimately lead to cirrhosis (permanent tissue scarring) and liver failure.
People with HIV who develop significant deposits of visceral fat have disturbed the production of growth hormone (GH), explains Steven Grinspoon, from Massachusetts General Hospital (MGH).
Grinspoon and his colleagues developed the drug tesamorelin (Egrifta), which triggers the physiologic production of GH and has been shown to reduce visceral fat by about 15 to 20 per cent.
It's approved by the Food and Drug Administration (FDA) for treating excess abdominal fat and irregular fat distribution in people with HIV.
The study showed that tesamorelin slowed the progression of fibrosis, or formation of scar tissue, which impairs liver function and can lead to cirrhosis: After 12 months, just two treated subjects (10.5 per cent) had advancing fibrosis compared to nine (37.5 per cent) in the placebo group. Overall, tesamorelin was well tolerated.
Grinspoon and colleagues are looking forward to furthering the development of tesamorelin for treating NAFLD in HIV patients.
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