Bioelectrical impedance analysis (often referred to as “BIA”) is an accurate method of estimating body cell mass. Instruments for reliable measurements of body composition are commercially available (., BIA Quantum; RJL Systems, Inc., Detroit). These devices can be used quickly in the office ( Figure 1 ) ; a minimum of staff training is required. Bioelectrical impedance analysis provides an estimate of the total body water by measuring changes in a low electrical current passed between electrodes placed on the upper and lower extremities. The sizes of other body compartments (including body cell mass) are then calculated using equations based on assumptions about the relationships between different body compartments and total body water. The validity and reliability of the results depend heavily on several factors, including correct placement of the electrodes, “normality” of body habitus, hydration status and the equations used to estimate body cell mass. 10
Recent studies have demonstrated the role of nandrolone decanoate (ND) in reversal of wasting associated with HIV infection. However, such studies in Indian scenario are lacking. Hence, the present study was planned with an objective to assess the effect of ND in patients of HIV-associated wasting in Indian subjects. The study was a prospective, randomised, multicentric, open labelled and comparative one in male HIV-infected subjects, aged between 18 and 65 years with involuntary weight loss of 10% over 12 months or % over 6 months or 5% over 3 months. The subjects were on stable antiretroviral therapy including at least 2 agents with CD, count > or =50 cells/microl. In the treatment group, ND (150 mg) intramuscularly every 2 weeks for 12 weeks was administered according to randomisation. Fat-free mass (FFM), body weight, CD4 count, and patient perception of treatment were the main outcomes measures. Of the 73 enrolled subjects, 69 completed study duration of 12 weeks. Compared to baseline, ND treated group demonstrated significant increase in FFM ( +/- kg; p < ) and body weight ( +/- kg; p < ) and control group demonstrated significant increase in body weight ( +/- kg; p < ) at the end of treatment period. Compared to control group, patient perception of benefit and subjective recovery of symptoms was significantly (p < .0001) greater in the ND group. None of the patients had any clinically significant deterioration of biochemical as well as laboratory safety parameters. Nandrolone was well tolerated with few reported adverse events of mild and non-serious in nature. Nandrolone improved patient perception of benefit and subjective recovery of symptoms in wasting associated HIV. Nandrolone therapy may prove to be effective and safe in reversing wasting associated with Indian HIV patients on antiretroviral therapy (ART) and nutritional replacement.