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Treatment With Nandrolone Decanoate and Megestrol Acetate in HIV-Infected Men

Cristina Cuerda, MD^*, Ana Zugasti, MD^*, Irene Bretón, MD^*, Miguel Camblor, MD^*, Pilar Miralles, MD and Pilar García, MD^*

^* Nutrition Unit and the Infectious Diseases Service, Hospital General Universitario "Gregorio Marañón," Madrid, Spain

Correspondence: Cristina Cuerda, MD, Nutrition Unit, Hospital General Universitario "Gregorio Marañón," C/Doctor Esquerdo 46, 28007 Madrid, Spain. Electronic mail may be sent to mcuerda.hgugm{at}salud.madrid.org.

Background: Malnutrition, especially loss of lean body mass, is a frequent complication of people living with HIV that may increase their mortality and morbidity. Methods: Nine HIV-infected men with unexplained loss of >10% of their usual weight were selected. They received megestrol acetate (MA) (400 mg/day by mouth) and nandrolone decanoate (ND) (100 mg/15 days intermuscular injection) over 16 weeks. Anthropometric evaluations, bioelectrical impedance, grip strength dynamometry, hematologic, biochemical, immunological and hormonal analysis before, during, and after the treatment were performed. Quality of life was evaluated by the Karnofsky index. Results: In the 7 men that finished the treatment, there were significant increases in weight (11.9 ± 9.1 kg, p < .05), 4-site skinfold measurements (p < .05), midarm circumference (p < .005), and fat-free mass (FFM) (5.1 ± 4.1 kg, p < .05). The increase in fat mass was not statistically significant (6.9 ± 6.4 kg, NS). Muscle strength increased significantly (p < .005). The Karnofsky index values increased from 59% to 73% (p < .05). One patient developed mild hyperglycemia and another one had an increase in aspartate transaminase and -glutamyl transpeptidase that reversed after the treatment. Four patients developed asymptomatic adrenal suppression. Testosterone serum levels decreased significantly during the study (p < .05), and 4 patients had serum values below the normal range at week 16. One patient developed gynecomastia. Conclusions: The combined treatment with MA and ND led to a significant increase in body weight and FFM. Muscle strength and quality of life improved during the study. The treatment was well tolerated with mild side effects.

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