Since it first became available in the 1990s, highly active antiretroviral therapy (HAART) has helped save countless lives and improve quality of life in thousands of HIV patients. Unfortunately, a side-effect of the HAART therapy was a rather dramatic change in body shape with a shift of fat to the abdominal region. At first thought, it may seem like an acceptable trade-off, but the fat accumulation isn’t purely cosmetic and has negative health implications.

The associated gain in abdominal fat is largely attributed to visceral adipose tissue (VAT). This type of fat is deep in the abdomen and surrounds the organs, hence “visceral”. This is different than subcutaneous fat which can be thought of as the “jiggly” fat underneath the skin. VAT is associated with numerous disease states such as insulin resistance (leading to Type 2 diabetes), hypertriglyceridemia (high trigylcerides), metabolic syndrome and heart disease.

Enter Tesamorelin (trade name Egrifta). Approved in 2010 and developed by the Canadian pharmaceutical company Theratechnologies for the use in the treatment of HIV-associated lipodystrophy, this peptide hormone has recently gained a lot of attention from the performance enhancement and age-management community.

Tesamorelin is a synthetic growth hormone releasing factor with all 44 amino acids with the addition of trans-3-hexenoic acid. This modified format is more potent and stable than the natural peptide.

This peptide hormone stimulates the release of growth hormone (GH), with a resultant increase in insulin-like growth factor (IGF-1) after passing through the liver. The outcome is a change in body composition through a combination of anabolic and lipolytic (fat-burning) means. In addition, Tesamorelin has been show to decrease triglyceride levels.

The benefits of Tesamorelin may include the following:

  • Reduce triglycerides
  • Improve cognition in patients over 60
  • Decreased carotid intima media thickness (cIMT) – a decrease in this measurement is associated with less atherosclerotic vascular disease
  • Decrease c-reactive protein (inflammatory blood marker
  • Decreased abdominal fat
  • Increase protein synthesis

Contraindications

  • Type II diabetes
  • Disorders of the pituitary gland
  • Cancer
  • Pregnant women
  • Children less than 18 years of age

Side Effects

  • Hypersensitivity (rash, urticaria)
  • Extremity pain
  • Hyperglycemia
  • Injection site reactions (redness, itching, pain, irritation, swelling)

Before starting Tesamorelin, it is recommended you discuss with your doctor and evaluate your blood for markers such as triglycerides, blood sugar, HbA1C, IGF-1, liver enzymes. 

References

1. Dhillon S. Spotlight on tesamorelin in HIV-associated lipodystrophy. BioDrugs2011 Dec 1;25(6):405-8

2. Mangili A, Falutz J, Mamputu JC, Stepanians M, Hayward B. Predictors of Treatment Response to Tesamorelin, a Growth Hormone-Releasing Factor Analog, in HIV-Infected Patients with Excess Abdominal Fat. PLoS One2015;10(10):e0140358. \

3. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Tesamorelin. [Updated 2018 Oct 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548730/

4. Falutz J, Mamputu JC, Potvin D, Moyle G, Soulban G, Loughrey H, Marsolais C, Turner R, Grinspoon S. Effects of tesamorelin (TH9507), a growth hormone-releasing factor analog, in human immunodeficiency virus-infected patients with excess abdominal fat: a pooled analysis of two multicenter, double-blind placebo-controlled phase 3 trials with safety extension data. J Clin Endocrinol Metab2010 Sep;95(9):4291-304.