What is the role of appetite stimulants in the treatment of HIV infection?

Updated: Apr 09, 2019
  • Author: Fazia Mir, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Answer

Megestrol is a synthetic oral progestin that has been widely used in advanced breast cancer and has been shown to stimulate appetite and cause non – fluid weight gain in advanced hormone nonresponsive cancers. In 1993, megestrol acetate was approved by the Federal Drug Administration for the treatment of anorexia, cachexia, or unexplained weight loss in patients with AIDS.

A Cochrane database review of randomized controlled trials, which are few, showed an improvement of appetite and weight gain with use of megestrol, but, due to small number of patients, methodological shortcomings, and poor reporting, recommendations regarding its use could not be made. [31]

Two randomized controlled trials of megestrol acetate therapy in patients with AIDS and weight loss resulted in improvement in appetite, weight gain, and patient perception of well-being at doses of 800 mg/day. Although lean body mass was reported to have improved, much of the weight gain was due to increase in fat mass. [32, 33] Long-term follow-up data regarding maintenance of weight, impact on morbidity, and survival is lacking.

Megestrol has been shown to bind to the glucocorticoid receptor and exhibit glucocorticoid activity with manifestations of hyperglycemia, suppression of hypothalamic-pituitary axis and adrenal insufficiency, addisonian crisis after abrupt withdrawal being reported in literature. It has a greater potential for suppression of the hypothalamic-pituitary axis than manifestations of peripheral glucocorticoid activity. [34, 35] When discontinuing megestrol therapy, slow taper rather than abrupt stopping is suggested. The possibility of adrenal insufficiency should be considered in patients on long-term and high-dose megestrol therapy. These patients may require stress-dose glucocorticoid therapy at times of surgery and critical illness.


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