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Egrifta reduces hepatic fat fraction in patients with NAFLD, HIV

Treatment with Egrifta demonstrated a greater reduction in hepatic fat fraction compared with placebo among patients with nonalcoholic fatty liver disease and HIV, according to study results.

NAFLD can be more prevalent and more likely to progress in patients with HIV than in the general population, even among patients with will-treated HIV and higher CD4-T counts, according to Takara L. Stanley, MD, from the Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts, and colleagues.

“In people with HIV, weight gain, abdominal fat accumulation, and increases in visceral fat are common and seen even with newer antiretrovirals,” the researchers wrote. “There are no proven therapies for NAFLD in people with HIV, nor is it known how strategies to reduce liver fat would aect progression of histological changes over time, and thus alter the natural history among people with HIV.”

The randomized control study comprised 61 patients, of whom 33% had nonalcoholic steatohepatitis, who received either Egrifta (tesamorelin, Theratechnologies) or placebo. Tesamorelin is a growth hormone-releasing hormone analogue that restores endogenous pulsatile growth hormone secretion and reduces visceral fat in individuals with HIV infection.

Treatment with tesamorelin reduced hepatic fat fraction by 37% (95% CI, –67 to –7) at 12 months compared with 4.1% (95% CI, –7.6 to –0.7) in the placebo group, and more patients in the treatment group demonstrated a reduction to less than 5% (35% vs. 4%; P = .0069).

While treatment did not improve existing fibrosis, tesamorelin prevented the progression of fibrosis during the treatment period with two treated patients showing progression compared with nine patients in the placebo group (P = .044).

Tesamorelin also reduced visceral adipose tissue area compared with placebo (–35; 95% CI, –66 to –4) and demonstrated a modest increase in lean body mass.

The researchers observed no serious adverse events correlated to treatment.

Tesamorelin is FDA approved to reduce visceral fat in people with HIV with central adiposity. “Our data show that tesamorelin robustly decreases liver fat, while preventing fibrosis progression, in association with improvement in indices of liver inammation among people with HIV and NAFLD [and] suggest that it might be beneficial among the larger group of people with HIV and NAFLD,” Stanley and colleagues concluded. – by Talitha Bennett

Disclosures: Stanley received funding from Novo Nordisk for an investigator-initiated grant unrelated to the current project. Please see the full study for all other authors’ relevant financial disclosures.