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VAT Reduction in People With HIV
Honing in on Visceral Adipose Tissue Reduction in People Living With HIV 

Released: March 27, 2026

Richard A. Elion
Richard A. Elion, MD
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Key Takeaways
  • Tesamorelin has been FDA approved for weight management in people living with HIV since 2010.
  • Tesamorelin affects the stimulation of growth hormone to promote loss of visceral adipose tissue without muscle loss.

In addition to the widely known GLP-1 receptor agonists (RAs), there is another drug that has been FDA approved for reducing excess visceral abdominal fat in people living with HIV. This drug, tesamorelin, was initially approved in 2010 for daily reconstitution and injection. A new formulation was approved in 2025 that allowed it to be reconstituted once a week for daily subcutaneous injections, at just half the original volume.

Tesamorelin is an analog of growth hormone–releasing hormone. It works by stimulating the pituitary gland to synthesize and secrete higher levels of the endogenous growth hormone, which increases insulin-like growth factor 1 levels, eventually resulting in increased lipolysis and reduced abdominal fat.

In 2 large phase III clinical trials, among people living with HIV who also had excess visceral adipose tissue (VAT) at baseline, tesamorelin was associated with a decrease in both VAT and 10-year cardiovascular disease risk score. This was accompanied by a significant improvement in muscle density and muscle area. I think this is important because other drugs, such as the GLP-1 RA semaglutide, have been associated with decreases in muscle as one loses weight.

The root cause of these differences may be their different mechanisms: Tesamorelin acts on the lipolysis pathway that specifically reduces VAT and changes body composition, whereas the GLP-1 RAs are primarily appetite suppressants that decrease caloric intake, but also have a host of other effects, such as possible improvements in cardiovascular disease risk and anti-inflammatory effects.

Something for Everyone?
When creating a weight management plan for patients, it is important to consider the whole picture, including individual preference, safety, comorbidities, and availability. Tesamorelin and GLP-1 RAs have different mechanisms and different side effects, so it is important to find the correct medication for each individual.

Furthermore, although both drugs are considered safe, tesamorelin may increase the risk for diabetes, glucose intolerance, and cancer in rare cases. Meanwhile, major risks with GLP-1 RAs include pancreatitis and issues with the kidneys and gallbladder.

My Experience
Overall, my experience with tesamorelin, although limited, has been positive. I've had a few patients, primarily women, who have used it successfully. These patients originally had excessive weight gain and were unable to manage their weight with nonpharmaceutical interventions. They couldn't afford liposuction or surgical interventions, and they wanted to try an agent that acted on metabolic pathways to help manage their weight. They were very interested in tesamorelin because they'd heard that the use of agents affecting growth hormone could be helpful.

GLP-1 RAs have certainly been more commonly used. But tesamorelin can be a useful alternative for people who can’t use GLP-1 RAs because they cannot tolerate them or find them ineffective. Ultimately, this drug allows people to stay on their antiretroviral therapy and manage their weight, and I think they continue to be a very useful option in our toolbox.

Your Thoughts
What has been your experience with tesamorelin or GLP-1 RAs for weight management in people living with HIV? Leave a comment to join the discussion!

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