March 9, 2006
The oral anabolic steroid oxandrolone is effective in restoring muscle and fat tissue that many HIV-positive people lose, according to a study published in the March issue of the Journal of Acquired Immune Deficiency Syndromes, Reuters Health reports (Norton, Reuters Health, 3/8). HIV-related wasting is a complication in which people lose a significant percentage of their normal weight, leaving them at risk for secondary infections. Carl Grunfeld of the University of California-San Francisco and colleagues gave 262 HIV-positive men who had experienced weight loss greater than or equal to 10% to 20% of their body mass index either oxandrolone -- in doses of 20 mg, 40 mg or 80 mg -- or a placebo daily for 12 weeks (Grunfeld et al., JAIDS, March 2006). The men who took the steroid in all dose levels had gained weight and muscle tissue, researchers found. The steroid also produced side effects, including an increase in LDL cholesterol, which is considered unhealthy cholesterol, and a decrease in HDL cholesterol, which is considered healthy cholesterol, the study finds. Some of the men also showed signs of liver toxicity, according to the study. Current therapies for tissue loss, including nutritional supplements and a drug called megestrol acetate, mostly increase body fat, and growth hormone therapies, which also can treat tissue wasting, increase muscle mass but decrease fat stores, Reuters Health reports. Anabolic steroids like oxandrolone restore both tissue and fat, Grunfeld said, adding that the benefits must be weighed against the side effects. Grunfeld also said that although oxandrolone is not specifically approved for HIV-related wasting, physicians may prescribe it to treat the condition (Reuters Health, 3/8).
San Jose Mercury News Examines Skin Treatment Used for Facial Wasting
In related news, the San Jose Mercury News on Tuesday examined the skin treatment Sculptra and its use in HIV-positive patients who are experiencing a condition known as facial lipoatrophy, or facial wasting (Wronge, San Jose Mercury News, 3/7). The condition, which is associated with HIV/AIDS and thought to be a side effect of antiretroviral drug therapy, results in the loss of fat beneath the skin leading to sunken cheeks and eyes and indentations on the face. Although the condition does not pose a physical danger, it can lead to depression and other psychological conditions. FDA in 2004 approved Sculptra, which is manufactured by French drug maker Aventis, to treat the condition (Kaiser Daily HIV/AIDS Report, 8/4/04). According to the Mercury News, the treatment, which consists of a series of injections under the skin, is simple and takes about 90 minutes. Patients need approximately three to six courses of treatment -- which can cost more than $1,000 for each course -- for lasting results. However, "touch-ups" are necessary about every two years, the Mercury News reports. While Kaiser Permanente patients only pay $5 for one course of treatment, other HMOs -- including Blue Cross of California, Medi-Cal and PacifiCare -- cover the treatment on a case-by-case basis if deemed medically necessary, the Mercury News reports. Dana Van Gorder, a lobbyist with the San Francisco AIDS Foundation, said he is urging state lawmakers to cover Sculptra and similar treatments, noting that patients might interrupt their antiretroviral regimen in fear of developing the condition. "On a technical level, facial wasting is a byproduct of the HIV disease process as well as the treatment, so it ought to be dealt with as reconstructive surgery," Van Gorder said (San Jose Mercury News, 3/7).