Use of growth hormone and other anabolic agents in AIDS wasting

JPEN J Parenter Enteral Nutr. 1999 Nov-Dec;23(6 Suppl):S202-9.

Use of growth hormone and other anabolic agents in AIDS wasting.

Mulligan K, Tai VW, Schambelan M.

Division of Endocrinology, San Francisco General Hospital, CA 94110, USA.

Body wasting and loss of lean body mass (LBM) have been associated with increased
mortality and disease progression, and reduced quality of life, in patients with
human immunodeficiency virus (HIV) infection. The failure of nutritional
therapies and, more recently, of effective viral suppression, to consistently
restore LBM has prompted investigation of the pharmacologic use of a number of
specific protein anabolic agents, including recombinant human growth hormone
(rhGH), insulin-like growth factor I (rhIGF-I), and synthetic testosterone
derivatives, such as nandrolone decanoate, oxandrolone, and oxymetholone. In a
placebo-controlled trial, treatment with rhGH resulted in a significant and
sustained increase in weight that was accompanied by an even greater increase in
LBM and a decrease in fat, and improvement in treadmill work output. Preliminary
data suggest that short-term rhGH treatment may be effective in mitigating weight
loss in patients with secondary infections. Open-label studies of nandrolone
decanoate suggest that this injectable agent also can increase weight and LBM.
Two oral agents, oxandrolone and oxymetholone, can increase weight, but their
effects on LBM in placebo-controlled trials have not been reported. Taken
together, these studies demonstrate that HIV-infected individuals can regain
weight and LBM under the proper therapeutic circumstances. The effects of
reversal of wasting on survival and disease progression, long-term safety, and
the potential value of these therapies in the treatment of fat redistribution
remain to be determined.

Treatment results of 23 cases of severe aplastic anemia with lymphocytapheresis

Arch Med Res. 1997 Spring;28(1):85-90.

Treatment results of 23 cases of severe aplastic anemia with lymphocytapheresis.

Morales-Polanco MR, Sánchez-Valle E, Guerrero-Rivera S, Gutiérrez-Alamillo L,
Delgado-Márquez B.

Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F.

We report the results of 23 patients with aplastic anemia (AA) treated with a
program of 14 lymphocytapheresis (LC). Treatments were performed with apheresis
machines, models Haemonetics 30-S and Baxter CS3000, using the standard program.
This procedure was done because AA in many cases appears as a result of the
action of a T cell population that inhibits hematopoiesis. Theoretically, removal
of this clonal population would produce hematopoietic recovery. Of the total of
23 patients, 9 were excluded for final evaluation of treatment results because 7
died during or shortly after treatment (0.7-3 months); one patient abandoned
treatment after three LC and another died 7 months later because of
transformation to acute leukemia. The remaining 14 patients were included in the
final evaluation of treatment; seven females and seven males, average age 46.1
years (range 22-69); 13 with severe, and one with moderate AA; 11 with recently
diagnosed, and 3 with chronic AA; 12 without previous treatment and two treated
before with antilymphocyte globulin + oxymetholone (OXM) + cyclosporine A (CsA)
with transient partial remission (PR). Besides lymphocytapheresis, 13 patients
received OXM; 4 of them GM-CSF and one low dose CsA. Four patients had complete
remission lasting > 59.5 months (range 42-78); eight PR (average duration of >
38.6 months), and two minimal remission (> 37 and 29 months). Platelet,
reticulocyte and granulocyte counts increased on average at 48.7, 73.3 and 91.4
days, respectively. In conclusion, 14 (60.8%) of 23 patients with AA showed an
improvement related to LC treatment, with a survival probability of 63% from the
fourth month, the latter with an added beneficial effect of the other therapies
used. Larger numbers of patients have to be treated with LC to determine its real
usefulness, mechanism of action and the best conditions for its use.

Effect of extended use of single anabolic steroids on urinary steroid excretion and metabolism

J Chromatogr. 1989 Apr 7;489(1):121-6.

Effect of extended use of single anabolic steroids on urinary steroid excretion
and metabolism.

Harrison LM, Martin D, Gotlin RW, Fennessey PV.

Department of Pediatrics, University of Colorado, Denver 80262.

Long-term use of single anabolic steroids by weightlifters and body builders at
dosages greater than or equal to 25 mg per 24 h resulted in reduced excretion of
urinary androgen metabolites, androsterone and etiocholanolone, compared to
values prior to anabolic use. The excretion of major urinary metabolites of
glucocorticoids was not affected by anabolic use. Urinary excretion of anabolic
steroids or anabolic metabolites averaged 20-25% of total anabolic steroid
administered. The major excreted metabolites of methandrostenolone, nandrolone,
oxandrolone and oxymetholone were identified by gas chromatography-mass
spectrometry based on the major mass spectral ion peaks.

Oxandrolone treatment of childhood hereditary angioedema.

Ann Allergy Asthma Immunol. 2004 Mar;92(3):377-8.

Oxandrolone treatment of childhood hereditary angioedema.

Church JA.

Division of Clinical Immunology and Allergy, Department of Pediatrics, Childrens
Hospital Los Angeles and Keck of School of Medicine, The University of Southern
California, Los Angeles, California 90027, USA. jchurch@chla.usc.edu

BACKGROUND: The virilizing effects of danazol, stanozolol, and methyltestosterone
significantly restrict the usefulness of these agents in the treatment of
children with hereditary angioedema (HAE). Oxandrolone is a synthetic anabolic
steroid with limited virilizing effects that has been used in a variety of
pediatric conditions and has an acceptable safety profile.

OBJECTIVE: To report
the effective use of oxandrolone in a 6-year-old boy with recurrent,
life-threatening episodes of angioedema.

METHODS: Oxandrolone was administered at
a dose of 0.1 mg/kg per day. Symptoms and laboratory findings were evaluated by
parental report and laboratory analysis of serum C1 esterase inhibitor and C4
levels, respectively.

RESULTS: Oxandrolone therapy resulted in a marked reduction
in clinical episodes and normalization of serum complement levels; cessation of
oxandrolone therapy resulted in recurrence of symptoms and decreased complement
levels. However, early signs of virilization were noted.

CONCLUSIONS: Oxandrolone
treatment was associated with significant clinical and laboratory evidence of a
therapeutic effect in a prepuberal boy with HAE. It is imperative to treat HAE
with the lowest dose of oxandrolone that controls life-threatening episodes of
angioedema

Hepatic effects of 17 alpha-alkylated anaboli-androgenic steroids.

HIV Hotline. 1998 Dec;8(5-6):2-5.

Hepatic effects of 17 alpha-alkylated anaboli-androgenic steroids.

[No authors listed]

AIDS: Use of 17 alpha-alkylated anabolic-androgenic steroids (17alpha-AAS) has
been connected to hepatotoxicity. These steroids are used clinically to treat
anemia, to prevent weight loss, and to treat wasting syndrome. The most common
types of 17alpha-AAS are Methyltestosterone, Oxandrolone, Oxymetholone and
Stanozolol. Liver disease and the effects of some anti-HIV drugs may contribute
to hepatic dysfunction. Signs of hepatic dysfunction are listed. For those
experiencing jaundice and related malfunctions, discontinuing the drug enables
patients to recover. In many cases those who did not exhibit jaundice may have
developed a tolerance for the drugs. Side effects such as cholestatic jaundice
only occurred in a small number of patients taking the recommended doses of
17alpha-AAS. Peliosis hepatitis, hepatic tumors, and hepatocellular adenomas are
other reported side effects. Proper dosing and monitoring of anabolic steroids
reduces the risk of hepatotoxicity.