Tesamorelin reduces visceral fat and improves metabolic parameters in HIV-infected patients

This comprehensive review, published by Takara Stanley and Steven Grinspoon from Massachusetts General Hospital/Harvard Medical School, compiled the available evidence on tesamorelin, a synthetic GHRH analog with a trans-3-hexenoic acid modification that confers greater stability and potency compared to native GHRH.

The authors detailed the mechanism of action of tesamorelin, which works by stimulating pulsatile growth hormone (GH) release from the anterior pituitary, promoting subsequent increases in circulating IGF-1 and activation of visceral lipolysis. Unlike direct GH administration, tesamorelin preserves the physiological regulation of the somatotropic axis, resulting in lower incidence of metabolic adverse effects.

• The review confirmed reductions of 15-18% in visceral fat in the pivotal trials
• There was improvement in lipid parameters, including triglycerides and cholesterol
• The impact on insulin resistance was neutral to slightly favorable
• Treatment discontinuation resulted in gradual re-accumulation of visceral fat

The authors concluded that tesamorelin represents a unique therapeutic option for HIV-associated lipodystrophy, with a well-established efficacy and safety profile. The review also discussed potential future applications of tesamorelin in other conditions associated with excess visceral fat, such as non-alcoholic fatty liver disease.