Tesamorelin (Egrifta): GHRH Analogue for HIV Lipodystrophy
Synthetic GHRH analogue. FDA-approved for HIV-associated visceral-fat excess; reduces abdominal fat by ~18%.
✅ Approved
- Full name
- Tesamorelin acetate
- Class
- Growth hormone-releasing hormone (GHRH) analogue
- Half-life
- ~26 minutes (effect outlasts)
- Route
- Subcutaneous daily
- Brand names
- Egrifta / Egrifta SV (Theratechnologies)
- Regulatory status
- FDA-approved 2010 for HIV-associated lipodystrophy
What it is
Tesamorelin is a 44-amino-acid GHRH analogue stabilised by an N-terminal trans-3-hexenoyl modification. It binds the pituitary GHRH receptor, triggering endogenous, pulsatile GH release that preserves normal physiologic feedback — distinct from exogenous GH therapy.
How it works
The GHRH receptor on somatotroph cells couples to cAMP and calcium signalling, driving GH exocytosis. Because release is pulsatile and sensitive to somatostatin/IGF-1 feedback, IGF-1 rises within the normal physiologic range rather than being pushed supraphysiologically.
The preferential reduction of visceral adipose tissue in HIV lipodystrophy reflects GH’s lipolytic action on visceral depots. Effects on liver fat have driven interest in NAFLD indications.
What the research shows
Pivotal trials in HIV-associated lipodystrophy and exploratory studies in NAFLD.
Falutz J. et al. (2007) — Phase 3 HIV lipodystrophy
Falutz J. et al., N Engl J Med 2007;357:2359–2370. 👥 Human studies
412 HIV patients with abdominal fat accumulation randomised 2:1 to tesamorelin 2 mg daily or placebo for 26 weeks.
Visceral adipose tissue reduced 15–20% vs ~2% placebo. Triglycerides improved; subcutaneous fat was minimally affected.
Limitations: Effect lost within 6 months of stopping treatment; IGF-1 rises can be clinically relevant.
Stanley TL et al. (2019) — NAFLD in HIV
Stanley T.L. et al., Lancet HIV 2019;6:e821–e830. 👥 Human studies
61 HIV patients with NAFLD received tesamorelin or placebo for 12 months.
Hepatic fat fraction decreased 32% vs 4.5% placebo; fibrosis progression was reduced.
Limitations: Small; HIV-specific population; transient glucose effects.
Safety and limitations
Well tolerated in HIV lipodystrophy trials. Common: injection-site reactions, arthralgias, transient paresthesia. Monitor fasting glucose — elevations are small but consistent with GH physiology.
Contra-indicated in active malignancy; not for use after organ transplant or in pituitary tumour.