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Strawford Alison; Barbieri, Teresa; Neese, Richard; Van Loan, Marta; Christiansen, Mark; Hoh, Rebecca; Sathyan, Gayatri; Skowronski, Roman; King, Janet; Hellerstein, Marc
Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology: February 1st, 1999

Summary:Serum testosterone concentrations are frequently in the low-normal range (lowest quartile, <500 ng/dl) in men with AIDS-wasting syndrome (AWS) and in other chronic wasting disorders. The response of patients in this group to androgen treatment has not been determined, however. Eighteen men with AWS (mean ± standard error [SE]: 87% ± 1% usual body weight; CD4 count 90 ± 24) and borderline low serum testosterone concentrations (382 ± 33 ng/dl) completed a 21-day placebo-controlled inpatient metabolic ward study comparing intramuscular (IM) placebo (n = 7) with low-dose (65 mg/week; n = 4) and high-dose (200 mg/week; n = 7) nandrolone decanoate, a testosterone analogue. Nitrogen balance, stable isotope-mass spectrometric measurement of de novo lipogenesis (DNL), resting energy expenditure, and gonadal hormone levels were measured. Both low-dose and high-dose nandrolone resulted in significant nitrogen retention (33-52 g nitrogen/14 days, representing gains of 0.5 to 0.9 kg lean tissue/week) compared with placebo (loss of 11 g nitrogen/week). This was reflected biochemically in a borderline significant reduction of high DNL (p < .06). Serum testosterone and gonadotropins were suppressed whereas resting energy expenditure was unchanged by nandrolone treatment. In 10 study subjects completing a 12-week open-label follow-up phase, body weight increased by 4.9 ± 1.2 kg, including 3.1 ± 0.5 kg lean body mass, and treadmill exercise performance also improved. In summary, nandrolone decanoate therapy in the absence of an exercise program in borderline hypogonadal men with AWS caused substantial nitrogen retention compared with placebo, similar in extent to the nitrogen retention previously achieved with recombinant growth hormone. It is reasonable to expand the criteria for androgen treatment in AWS to include at least patients in the lowest quartile of serum testosterone.

Address correspondence and reprint requests to Marc Hellerstein, Department of Nutritional Sciences, 309 Morgan Hall, University of California at Berkeley, Berkeley. CA 94720, U.S.A.;

Portions of the material presented here have been previously presented in abstract form at the 2nd International Conference on Nutrition and HIV Infection, Cannes, 1997.

Manuscript received June 5, 1998; accepted September 29, 1998.

© 1999 Lippincott Williams & Wilkins, Inc.