BACKGROUND:

Growth hormone (GH)/insulin-like growth factor (IGF)-1 axis abnormalities have been associated with bodycomposition changes among HIV-infected persons with wasting or lipodystrophy. Little is known of GH/IGF-1 axis alterations with ARTinitiation or differing ART therapies.

METHODS:

The AIDS Clinical Trials Group Prospective Evaluation of Antiretrovirals in Resource- Limited Settings (PEARLS) study was a prospective, randomized clinical trial of ART initiation with emtricitabine/tenofovir + efavirenz (FTC/TDF+EFV) vs lamivudine/zidovudine + efavirenz (3TC/ZDV+EFV) in HIV-1-infected individuals from resource-diverse settings. IGF-1 was measured from baseline, week 48, and week 96 stored serum samples. Multivariate models were constructed.

RESULTS:

415 participants were included: 170 (41%) were randomized to FTC/TDF+EFV and 245 (59%) to 3TC/ZDV+EFV. The mean age was 35 years, 60% were black, 42% women. The mean IGF-1 level did not change significantly from baseline to week 96 (-0.65 ng/mL; CI -5.18, 3.87), p=0.78 and there were no differences by treatment arm at week 96, p=0.74. Lower baseline IGF-1 was associated with age, non-white race, greater waist-hip ratio (WHR), low CD4 count and lower baseline albumin (all p<0.01) but not plasma HIV-1 RNA, body mass index (BMI), or treatment arm. Greater change in IGF-1 from baseline to 96 weeks was associated with female sex, smaller WHR change, lower baseline albumin and higher baseline HIV-1 RNA (all p<0.01).

CONCLUSIONS:

ART initiation with either ZDV or TDF did not significantly impact overall IGF-1 levels. Baseline and on-treatment changes in IGF-1 with ART initiation may be related to the body composition changes that occur after ART initiation.