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HIV patients treated with antiretroviral therapy (ART) often develop increased visceral adipose tissue (VAT).Our objective was to perform a pooled analysis of two phase-3 studies of tesamorelin in ART-treated HIV patients with excess abdominal fat.Two multicenter, international studies were conducted; a 26-wk randomized, placebo-controlled primary intervention phase was followed by a 26-wk safety extension.A total of 806 ART-treated HIV patients with excess abdominal fat were randomized in a 2:1 fashion to receive tesamorelin 2 mg (n = 543) or placebo (n = 263) sc daily. At wk 26, patients initially on tesamorelin were rerandomized to 2 mg tesamorelin (T-T group, n = 246) or placebo (T-P, n = 135) for an additional 26 wk, whereas patients on placebo were switched to tesamorelin (P-T, n = 197).Tesamorelin (GHRH1-44) at a dose of 2 mg or identical placebo, sc, was given daily.We evaluated percent change in VAT by computed tomography scan at wk 26.At wk 26, VAT decreased significantly in tesamorelin-treated patients (−24 ± 41 vs. 2 ± 35 cm2, tesamorelin vs. placebo, P < 0.001; treatment effect, −15.4%). No significant changes were observed in abdominal sc adipose tissue (−2 ± 32 vs. 2 ± 29 cm2, P = 0.08; treatment effect, −0.6%). Treatment with tesamorelin resulted in significant decreases in triglycerides (−37 ± 139 vs. 6 ± 112 mg/dl, P < 0.001; treatment effect, −12.3%) and cholesterol to high-density lipoprotein ratio (−0.18 ± 1.00 vs. 0.18 ± 0.94, P < 0.001; treatment effect, −7.2%) vs. placebo. Tesamorelin improved body image [belly appearance distress (P = 0.002)], patient rating of belly profile (P = 0.003), and physician rating of belly profile (P < 0.001). Mean IGF-I increased 108 ± 112 vs.−7 ± 64 ng/ml (P < 0.001 vs. placebo). At wk 52, decreases in VAT [−35 ± 50 cm2 (−17.5 ± 23.3%)], waist circumference (−3.4 ± 6.0 cm), triglycerides (−48 ± 182 mg/dl), cholesterol (−8 ± 38 mg/dl), and non-high-density lipoprotein (−7 ± 38 mg/dl) were maintained (all P < 0.001 vs. original baseline) in the T-T group. Treatment with tesamorelin was generally well tolerated. No clinically meaningful differences were observed between groups in glucose parameters at wk 26 and 52.Treatment with tesamorelin reduces VAT and maintains the reduction for up to 52 wk, preserves abdominal sc adipose tissue, improves body image and lipids, and is overall well tolerated without clinically meaningful changes in glucose parameters.