Abstract
We were recently asked to advise on hormone replacement therapy (HRT) for a postmenopausal, human immunodeficiency virus (HIV)—positive woman who was taking megestrol acetate (160 mg twice daily) for decreased appetite secondary to HIV-associated anorexia. She had been receiving estrogen and medroxyprogesterone acetate (Provera) as HRT for 5 years before she was diagnosed as having HIV. Megestrol acetate (Megace), a synthetic progestin, has been clinically proved to increase appetite and weight in HIV-positive patients at doses of 400 to 800 mg/d.<sup>1,2</sup>In one trial comparing megestrol and placebo, lean body mass change from baseline was similar in both treatment groups, but fat mass increased significantly in the megestrol group. A second study showed a trend for weight gain with increasing doses of megestrol.<sup>2</sup>Together, these results suggest that the weight gain in patients taking the commonly prescribed doses of megestrol is predominantly fat. Adverse effects in men taking
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