E. Koller et al., Aseptic necrosis in HIV seropositive patients: A possible etiologic role for megestrol acetate, AIDS PAT CA, 14(8), 2000, pp. 405-410
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
.