Tesamorelin Dosing for HIV-Associated Abdominal Fat Accumulation
The recommended dose of tesamorelin for adults with HIV-associated abdominal fat accumulation is 2 mg administered subcutaneously once daily. 1, 2, 3
Reconstitution and Administration
Each 10 mg vial of tesamorelin should be reconstituted with the appropriate volume of sterile water for injection to achieve a final concentration that delivers 2 mg per injection. 1, 4, 5
Administer the 2 mg dose as a subcutaneous injection once daily, preferably at the same time each day. 1, 2, 3
The injection should be given in the abdomen, rotating injection sites to minimize local reactions. 4, 5
Treatment Duration and Expected Outcomes
Significant reductions in visceral adipose tissue (VAT) are typically observed after 26 weeks of continuous daily therapy, with VAT decreasing by approximately 15-24% compared to baseline. 1, 2, 3
For sustained benefit, treatment must be continued long-term; discontinuation results in rapid reaccumulation of visceral fat within weeks. 1, 3
Patients who continue tesamorelin for 52 weeks maintain VAT reductions of approximately 17-18% from baseline. 1, 3
Important Clinical Considerations
Metabolic Effects
Tesamorelin significantly reduces triglycerides (by approximately 37-50 mg/dL) and improves the total cholesterol to HDL ratio (by 0.18-0.31) compared to placebo. 1, 2
IGF-I levels increase substantially (by 81-108%) during treatment, which is the expected pharmacodynamic effect of growth hormone-releasing factor stimulation. 1, 2, 3
Importantly, no clinically meaningful changes in glucose parameters (fasting glucose, insulin, or HbA1c) occur with tesamorelin therapy, despite theoretical concerns about growth hormone effects on glucose metabolism. 1, 2, 3
Tolerability and Adverse Events
Tesamorelin is generally well tolerated, with the most common adverse events being injection-site reactions (erythema, pruritus, pain), arthralgia, peripheral edema, and headache—all consistent with growth hormone pathway activation. 1, 4, 5
Treatment-emergent serious adverse events occur in fewer than 4% of patients during 26 weeks of therapy. 4, 5
Withdrawal rates due to adverse events are higher in the tesamorelin group compared to placebo, though absolute rates remain low. 2
Body Composition Specificity
Tesamorelin selectively reduces visceral adipose tissue without significantly affecting subcutaneous abdominal fat, limb fat, or total body fat—a critical distinction from other interventions. 1, 2, 3
Trunk fat and waist circumference improve significantly, with reductions in waist circumference of approximately 3-4 cm after 52 weeks. 1, 3
Patient-Reported Outcomes
- Significant improvements occur in patient-rated belly appearance distress and both patient and physician ratings of belly profile. 1, 2, 3
Critical Pitfalls to Avoid
Do not discontinue tesamorelin abruptly without counseling patients that visceral fat will rapidly reaccumulate; this is not treatment failure but rather the expected pharmacologic effect of stopping a growth hormone-releasing factor. 1, 3
Do not withhold tesamorelin due to concerns about glucose dysregulation in HIV patients; the evidence consistently demonstrates no clinically meaningful changes in glycemic parameters despite IGF-I elevation. 1, 2, 3
Do not use tesamorelin to address subcutaneous lipoatrophy (peripheral fat loss); it is specifically indicated only for excess visceral adiposity and does not restore subcutaneous fat. 1, 2, 3