Growth hormone improves protein catabolism and growth in prepubertal children with HIV infection

Introduction: Poor linear growth and weight loss are well documented in children with human immunodeficiency virus (HIV) infection and past studies in adults and children have reported that loss of lean tissue mass (LTM) associated with accelerated rates of protein catabolism. We undertook this study to test the hypothesis that human recombinant GH would improve linear height in HIV-infected children. Our second goal was to determine if GH could reverse protein catabolism in HIV-infected children. Methods: We studied six HIV-infected children (mean age 9.2 years, Tanner stage I, CD4 counts 110 000-292 000, two girls, four boys). Measures of protein turnover were conducted using the stable isotope 1-[¹³C] leucine. Body composition was measured by dual X-ray absorptiometry (DXA) scan for determination of LTM. Viral burden and IGF-1 levels were measured. Studies were conducted at baseline and 6 months. Results: The baseline growth velocity of these children was only 3.9 cm/year. After 6 months of GH, growth velocity increased to 7.9 cm/year. Protein catabolism, represented as leucine rate of appearance (Ra) in the fasted state, was high at baseline, but decreased significantly after 6 months of GH therapy. Lean tissue mass significantly improved in all subjects. Viral burden did not increase significantly in any subject during GH therapy. Conclusion: These results suggest that GH improves height and weight and reduces protein catabolism in HIV-infected children without negative effect on viral burden.