Fat redistribution syndrome was not the only topic at this conference. A variety of pharmacologic and nonpharmacologic interventions are useful in patients with HIV-associated weight loss and wasting. Dr. Mary Romeyn from San Francisco reported a study of oxandrolone (20 mg/day) with or without supervised progressive resistance exercise in 13 male subjects. All patients had >5% weight loss at baseline and were followed for 3 months. The control group (oxandrolone alone) demonstrated an increase in both weight and BCM of 6.1 and 4.6 lbs. respectively; the oxandrolone/exercise group gained 8.7 and 5.8 lbs. respectively. Oxandrolone was discontinued in 3 patients: one for noncompliance and two for elevations of liver function tests (in the presence of underlying liver pathology). The effects on weight and BCM by oxandrolone with exercise were very similar to those seen in the recently published study by Strawford, et al, in the Journal of the American Medical Association.
Dr. Barry Albertson of Portland, Oregon used low-dose prednisone (10mg/day) as an appetite stimulant with oxandrolone (20 mg/day) in a study that compared this combination to oxandrolone alone and to placebo over 60 days. 39 patients (34 men) were included in this study. The combination therapy (prednisone/oxandrolone) group fared best in terms of weight gain (6.6 lbs.), as well as increase in fat-free mass (5.33 lbs.); the patients taking oxandrolone alone had a similar gain in FFM (5.36 lbs.) and weight (4.2 lbs). All of the subjects taking oxandrolone with/without prednisone had insignificant changes in total body fat. The placebo group lost weight and FFM but gained total body fat. Using a simple measurement of quality of life the oxandrolone/prednisone subjects reported increased activity and energy scores compared to the placebo subjects. No difference in adverse effects was seen in the three groups.
Dr. Wanke studied megesterol acetate (800 mg/day) and oxandrolone (20 mg/day) alone and in combination in 26 patients with >5% weight loss. Caloric intake, lean body mass, fat mass and BMI all increased significantly with 6 months of combination therapy. The lean body mass accounted for 53% of the total weight gain; fat mass for 47%. Dosage adjustments were very common with megace, less so with oxandrolone. Adverse effects were infrequent except for menstrual irregularities in 3 of 4 women in the study.
Dr. U.R. Henge from Essen, Germany reported on long-term follow-up of 30 subjects enrolled in a trial of oxymetholone (150 mg/day). 25 patients completed the previously reported 30-week study. 20 tolerated oxymetholone for 12 months or longer, 9 for 15 months or longer. 20% of patients treated for longer than 12 months showed a pattern of mild-to-moderate hepatotoxicity characterized by elevations of liver function tests only one of which was judged clinically significant. Weight increased by an average of 4.6 kg in the 30 patients treated beyond 30 weeks (average treatment duration 14.7 months); body composition analysis was not performed.
Cade Fields-Gardner reported a 12-week pilot study of oxymetholone (100 mg/day) in combination with testosterone in 32 men receiving stable testosterone replacement in Los Angeles. Though patients did not have deficits in weight or BCM at baseline both increased with the addition of oxymetholone (2.0 and 4.4 kg respectively). Adverse effects were not significant and some subjects reported improvement in symptoms of anorexia, depression or fatigue. Testosterone dosing was variable, generally at replacement levels. Exercise was not quantitated or monitored.