BACKGROUND: Substantial loss of muscle mass occurs among men with AIDS wasting. OBJECTIVE: To investigate the independent effects of testosterone therapy and progressive resistance training in eugonadal men with AIDS wasting. DESIGN: Randomized, controlled trial. SETTING: University hospital. PATIENTS: 54 eugonadal men with AIDS wasting (weight < 90% ideal body weight or weight loss > 10%). INTERVENTION: In a 2x2 factorial design, patients were assigned to receive testosterone enanthate (200 mg/wk) or placebo injections and progressive resistance training (three times weekly) or no training for 12 weeks. MEASUREMENTS: Cross-sectional muscle area and other indices of muscle mass. RESULTS: Cross-sectional muscle area increased in response to training compared with nontraining (change in arm muscle mass, 499 +/- 349 mm2 versus 206 +/- 264 mm2 (p = 0.004); change in leg muscle mass, 1106 +/- 854 mm2 versus 523 +/- 872 mm2 (p = 0.045)) and in response to testosterone therapy compared with placebo (change in arm muscle mass, 512 +/- 371 mm2 versus 194 +/- 215 mm2 (p < 0.001); change in leg muscle mass, 1,236 +/- 881 mm2 versus 399 +/- 729 mm2 (p = 0.002)). Levels of high-density lipoprotein cholesterol decreased in response to testosterone therapy compared with placebo (-0.03 +/- 0.13 mmol/L versus 0.05 +/- 0.13 mmol/L (1 +/- 5 mg/dL versus 2 +/- 5 mg/dL); p = 0.011) and increased in response to training compared with nontraining (0.05 +/- 0.13 mmol/L versus 0.00 +/- 0.16 mmol/L (2 +/- 5 mg/dL versus 0 +/- 6 mg/dL); p = 0.052). CONCLUSIONS: In contrast to anabolic therapies that may have adverse effects on metabolic variables, supervised exercise effectively increases muscle mass and is associated with significant positive health benefits in eugonadal men with AIDS wasting.

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