Overall, the risk of significant biases was low in all studies. The forest plots of the three primary outcomes demonstrate overall agreement in the estimation of treatment effect among all of the studies, which indicates that the results of this review are internally Staurosporine chemical structure valid and could be replicated by other reviewers undertaking the same project. For one study [3], estimation of changes in LBM from graphs in the published article was required, as numerical data were not available and we could not reach the authors. This may have resulted

in inaccuracies of data abstraction. We attempted to minimize this inaccuracy by having three authors extract this data independently and averaging the result. We estimate that any remaining inaccuracy is minimal. Furthermore, we arbitrarily decided that changes in VAT/SAT mass and LBM were the most important consideration, as most of the studies focused on

these outcomes as primary outcomes. However, Roxadustat other outcomes that we considered secondary outcomes may be more important in the clinical treatment of patients with HIV-associated lipodystrophy. The major limitation of our review is that there were few studies meeting our inclusion criteria for each specific class of GH axis intervention. Only one study evaluated the effect of IGF-1 or GHRH, and thus it is difficult to draw conclusions about these two treatments. Furthermore, most of the participants in the studies were male. This is an important consideration, as the pattern of fat distribution is different in men and women. Also, the perception of body image is different between men and women, and this was not considered in the studies. The most common route of acquisition of HIV infection is also different between men and women and this may reflect differences in the socio-economic and social climates of the

male vs. female participants. This may have affected the results. Furthermore, there was no consensus definition of HIV-associated lipodystrophy among the included studies, which may affect the clinical applicability Protein tyrosine phosphatase of the data. Finally, none of the studies examined the long-term benefits and risks of treatment, and very few evaluated whether the benefits were retained after discontinuation of treatment. No previous systematic reviews have evaluated the use of GH axis drugs for the treatment of HIV-associated lipodystrophy. Reviews have compared GH with other treatments, as mentioned above. Our present review complements the growing body of evidence regarding the efficacy of GH axis treatments for HIV-associated lipodystrophy. Overall, GH axis drugs compared with placebo were effective in significantly reducing VAT mass and increasing LBM. They also reduced SAT mass, but this result was not statistically significant. Statistically significant adverse effects of treatment were arthralgias and peripheral oedema.