Testosterone Replacement and Resistance Exercise in HIV-Infected Men With Weight Loss and Low Testosterone Levels

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Abstract
Weight loss during the course of human immunodeficiency virus (HIV) infection is associated with increased mortality and adverse disease outcome.1-4 Of the various therapies being considered for the treatment of HIV-associated weight loss, testosterone and exercise are attractive because they are relatively inexpensive and safe. There is a high prevalence of low testosterone levels in HIV-infected men.4-11 Serum testosterone levels are lower in those with weight loss9 and correlate with deficits in muscle mass,11 low Karnofsky scores,12 and disease progression.10,13 Replacement doses of testosterone augment lean body mass and muscle strength in healthy, hypogonadal men.14-16 These data have led to the hypothesis that testosterone replacement might also increase muscle mass and strength in HIV-infected men with low testosterone levels. Some of the studies17-29 that have examined the effects of androgen administration on weight and body composition in HIV-infected men were not placebo-controlled,23-27 and most failed to control energy intake and exercise stimulus.23-28 Two of the 4 placebo-controlled studies of testosterone supplementation of HIV-infected men17,18 reported gains in fat-free mass (FFM), while others19,20 found no change. None of the previous androgen studies in HIV-infected men has demonstrated improvements in muscle strength.17-20,23-28 The effects of resistance exercise alone and in combination with testosterone in HIV-infected men are unknown.