In a randomized, double-blind, multicenter trial, 412 patients with HIV-associated abdominal fat accumulation received daily subcutaneous injections of tesamorelin (2 mg) or placebo for 26 weeks. Visceral adipose tissue (VAT) was measured by computed tomography. Tesamorelin induced a significant 15.2% reduction in visceral fat volume compared with a 1.0% increase with placebo (P<0.001), while maintaining subcutaneous adipose integrity.