Megestrol for Appetite Stimulation and as a Progestin in Hormone Replacement Therapy

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.1,2In 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.2Together, these results suggest that the weight gain in patients taking the commonly prescribed doses of megestrol is predominantly fat. Adverse effects in men taking