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Drug found to help with fatty liver disease in patients with HIV

A side effect of antiviral medical in people with HIV is the development of abdominal fat deposits. But according to a new study, a drug Called tesamorelin (Egrifta) is available to help reduce those deposits. Now researchers have found that taking injections of tesamorelin also greatly reduced fat in the liver in patients who have fatty liver disease as well, which is another side effect of antiviral medications. Fatty liver disease can cause liver inflammation and damage.

“Tesamorelin’s ability to reduce liver fat in conjunction with the reduction of abdominal fat may be clinically important for patients with HIV infection who have fatty liver disease along with increased abdominal fat,” says Steven Grinspoon, MD, of the Massachusetts General Hospital’s Neuroendocrine Unit and Program in Nutrition Metabolism and senior author of the study. “While some patients with nonalcoholic fatty liver disease have a benign course, others may develop a more serious condition involving liver inflammation, cellular damage and fibrosis, which can progress to cirrhosis and end-stage liver disease or to liver cancer.”

About 30 and 40 percent of patients with HIV get nonalcoholic fatty liver disease (NAFLD), as opposed to liver disease caused by alcoholism. But NAFLD doesn’t always occur with the abdormal abdominal fat accumulation (called “lipodystrophy”) that happens in up 20 to 30 percent of patients on antiviral medications, according to a statement on the study released by Massachusetts General. Tesamorelin helps the body release growth hormone, which is reduced in HIV lipodystrophy.

In the study of 48 adult patients who were receiving antiretroviral treatment for HIV and had developed excessive abdominal fat deposits, participants first received daily injections of either tesamorelin or a placebo. Because growth hormone can cause increased blood sugar levels and reduced insulin sensitivity, half of participants in each group also had special testing to analyze insulin secretion and resistance at the beginning of the study and at three and six months. They also were assessed for factors related to HIV infection, abdominal fat by computerized tomography (CT) scan, and other tests.

At the end of the study, participants receiving tesamorelin had a substantial but modest-sized lowering in liver fat along with the reduction in overall abdominal fat. Participants on placebo showed increases in both measures. Tesamorelin treatment did appear to have reduced insulin sensitivity and it raised blood sugar levels at the three-month assessment, by six months both measures had returned to similar levels at the beginning of the study indicating that the drug’s impact on blood sugar levels was only temporary.

“Tesamorelin’s neutral long-term effects on insulin sensitivity and glucose are important, since HIV patients with abdominal fat accumulation may have underlying insulin resistance; so it’s important to know that won’t be worsened by this treatment,” says Grinspoon, a professor of Medicine at Harvard Medical School. “Since we know that liver fat is associated with inflammation in the liver, reducing it may result in less inflammation. Indeed levels of AST, a marker of liver inflammation, were reduced in response to tesamorelin in our study.

“Now we need to investigate the effects of tesamorelin in patients with the severe form of liver inflammation called nonalcoholic steatohepatitis, which can cause significant damage to liver cells, and examine whether reduced liver fat has other metabolic benefits,” he adds. “Tesamorelin also may be an effective treatment for non-HIV-infected patients with NAFLD, and that needs to be studied as well.”

The researchers also note that further studies are needed to determine the clinical importance and long-term consequences of these findings.