Regulation of the growth hormone/insulin-like growth factor-I axis in HIV disease

The growth hormone/insulin-like growth factor-I (GH/IGF-I) axis is significantly affected in human immunodeficiency virus (HIV) disease. Most often, physiologic regulation of the GH/IGF-I axis is linked closely to unique changes in nutritional status and body composition that are characteristic of HIV disease. Acquired growth hormone resistance, marked by increased growth hormone concentrations, occurs as a function of diminished weight and lean body mass in the acquired immunodeficiency syndrome (AIDS) wasting syndrome. Conversely, reduced growth hormone concentrations result from increased abdominal visceral adiposity in patients with the HIV lipodystrophy syndrome. Significant interest has focused on the use of growth hormone as a therapeutic strategy to increase muscle mass and weight in AIDS wasting and to reduce fat mass in HIV lipodystrophy. In this article, we review the physiologic regulation of the GH/IGF-I axis in HIV disease with a special emphasis on nutritional and body composition factors determining GH secretion and action in this population of patients. The use of growth hormone as an anabolic and lipolytic agent in HIV disease is also reviewed.