Farrar D J
Center for Special Studies, New York Hospital-Cornell Medical Center, New York, USA.
AIDS Patient Care STDS. 1999 Mar;13(3):149-52. doi: 10.1089/apc.1999.13.149.
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.
近期报告表明，有效的抗逆转录病毒疗法可使血浆中的艾滋病毒载量降至检测不到的水平，这本身可能会预防与艾滋病毒和机会性感染相关的体重减轻，并导致体重显著增加。尽管这些数据令人鼓舞，但显然仍有很大一部分患者此外还需要针对艾滋病毒相关消瘦进行特殊治疗。醋酸甲地孕酮，剂量范围为每天400至800毫克，是预防和治疗艾滋病毒相关消瘦的一种有用的食欲刺激剂，对女性尤其如此。需要告知患者可能的不良反应并进行密切监测。醋酸甲地孕酮主要通过增加身体脂肪来促进体重增加，因此在适当的情况下，与肌肉锻炼计划以及合成代谢剂（类固醇或生长激素）联合使用，以维持或增加瘦体重时最为有效。
