What is the role of anabolic steroids in the treatment of weight loss in HIV infection?

Updated: Apr 09, 2019
  • Author: Fazia Mir, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Physiologic testosterone replacement has been shown to increase lean body mass and improve quality of life among androgen-deficient men with the AIDS wasting syndrome. In a randomized double-blinded placebo-controlled study of HIV-positive men with wasting and testosterone deficiency, patients receiving intramuscular testosterone enanthate therapy gained fat-free mass, lean body mass, and muscle mass compared to placebo.

The changes in weight, fat mass, total-body water content, and exercise functional capacity did not significantly differ between the groups. [28] In a meta-analysis including 6 randomized, placebo-controlled trials that compared the effects of testosterone therapy with placebo in HIV patients with wasting, testosterone therapy increased lean body mass more than placebo. The increase was greater if the therapy is given intramuscularly. [29]

A Cochrane database review included 13 Randomized controlled trials that compared the use of an anabolic steroid to placebo to treat weight loss in adults with HIV for change from baseline in lean body mass or in body weight as outcome measures. Although the results of the trials were heterogeneous, on average, the administration of anabolic steroids appeared to result in a small increase in both lean body mass [1.3 kg (95% CI: 0.6, 2.0)], and body weight [1.1 kg (95% CI: 0.3, 2.0)] as compared with placebo, but, due to limitation in studies, no treatment recommendations could be made. [30] Studies for anabolic steroids in the HIV wasting syndrome are small and include bias necessitating larger studies that define the patient subset for which anabolic steroids will be useful and whether it translates into improvement in physical function and survival. In the presence of hypogonadism, testosterone replacement should be given consideration.

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