Megestrol acetate: promises and pitfalls

Recent reports suggest that effective antiretroviral therapy, resulting in a plasma HIV load that has been reduced to undetectable levels, may itself prevent HIV- and opportunistic infection-associated weight loss and lead to substantial weight gain. Although these data are encouraging, it is clear that a significant proportion of patients will require, in addition, specific treatment for HIV-associated wasting. Megestrol acetate, in the dosage range of 400 to 800 mg/day, is a useful appetite stimulant for the prevention and treatment of HIV-associated wasting, particularly in women. Patients need to be advised of possible adverse effects and monitored closely. Megestrol acetate stimulates weight gain mostly through an increase in body fat and is therefore most effective in combination with a muscle-building exercise program, where appropriate, and an anabolic agent (steroid or growth hormone) to maintain or increase lean body mass.