Testosterone supplementation of megestrol therapyproduces “robust” weight gain and preserves sexual function when givenwith testosterone, but does not enhance lean tissue accrual in men with HIV-associated weight loss, according to researchers.

In the February issue of The Journal of Clinical Endocrinology &Metabolism, Dr. Kathleen Mulligan of the University of California, SanFrancisco and colleagues note that although HAART has helped reduceHIV-associated wasting, weight and lean body mass are not fully orconsistently restored after its initiation.

Megestrol acetate, they add, can help by stimulating appetite andpromoting weight gain. However, much of the weight gained is fat.

To investigate whether testosterone might help increase lean bodymass, the researchers studied 79 HIV-positive men who had a body massindex of less than 20 or who had lost 5% of their body mass. They wererandomized to receive megestrol 800 mg daily along with testosteroneenanthate 200 mg or placebo.

At 12 weeks, the combination group had gained a median of 5.3 kg andthe placebo group had gained 7.3 kg. However, lean body mass accountedfor 3.3 kg in both groups. There were no significant differencesbetween groups in the magnitude or composition of weight gain.

There were also no differences between groups in sexual functioningat baseline. However, at the end of the study, sexual functioning wasunchanged or improved in the combination group, but worsenedsignificantly in the placebo group.

Dr. Mulligan told Reuters Health that “these results provide anotherdemonstration of the potent appetite-stimulating effects of megestrolacetate. However, clinicians should be aware of the potent suppressiveeffects of megestrol acetate on adrenal and gonadal hormones andcarefully monitor its use.”

Commenting on the findings, author of an accompanying editorial Dr.William J. Evans, added that “megestrol acetate suppresses testosteroneproduction, resulting in either loss of muscle -- or only fat as thetissue added with weight gain -- as well as reduced libido andimpotence.”

“Even replacing testosterone,” concluded Dr. Evans of the Universityof Arkansas for Medical Sciences, Little Rock, “appears to beineffective in adding muscle to the weight gain.”