Aseptic necrosis in HIV seropositive patients: A possible etiologic role for megestrol acetate

The association between pharmacologic doses of corticosteroids and the deve lopment of aseptic bone necrosis has been well documented. Recent reports h ave described the corticosteroid activity of megestrol acetate. A retrospec tive review of adverse events reported to the U.S. Food and Drug Administra tion identified three human immunodeficiency virus (HIV) seropositive patie nts who developed avascular necrosis of the femoral head during treatment w ith megestrol acetate. All were males, ages 34, 36, and 55 years, and were on therapy for 6, 1.5, and 18 months, respectively, when symptoms of asepti c necrosis occurred in the absence of antecedent trauma. Megestrol acetate doses were 640, 320, and 600-1200 mg/d, respectively. Two patients had no h istory of corticosteroid use whereas the third had taken an undisclosed dos e and duration of corticosteroids concurrent with pentamidine administratio n. Notably, despite the predominant use of megestrol in women for hormone s ensitive malignancies, none of the reports of aseptic necrosis occurred in this population. Megestrol acetate may be associated with the development o f avascular necrosis via its glucocorticoid-like effects. Cachectic acquire d immunodeficiency syndrome (AIDS) patients may have additional risk factor s that predispose them to aseptic necrosis when receiving megestrol acetate .