***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract : HIV-associated wasting is defined as ≥10 % involuntary weight loss and includes declines in both lean and fat mass . This large ( 757 subjects ) , r and omized , double-blind , placebo-controlled trial investigated the efficacy , safety , and tolerability of recombinant human growth hormone ( rhGH ) in 2 doses—0.1 mg/kg up to a maximum of 6 mg daily ( DD ) or alternate days (AD)—in the treatment of wasting and weight loss in highly active antiretroviral therapy (HAART)-treated HIV-infected subjects . The evaluable population for ergometry comprised 555 subjects , 87.6 % of whom were receiving HAART . At 12 weeks , median maximum work output increased by 2.4 and 2.6 kJ in the AD and DD groups , respectively . The median treatment difference was 2.9 kJ for DD vs. placebo ( P < 0.0001 ) . Body weight increased by 2.2 and 2.9 kg in the AD and DD groups , respectively . Corresponding median treatment differences vs. placebo were 1.5 and 2.2 kg ( P < 0.0001 ) . Lean body mass ( LBM ) , by bioelectric impedance spectroscopy , increased by 3.3 and 5.2 kg , respectively ( P < 0.0001 vs. placebo ; P = 0.0173 DD vs. AD ) , and fat mass , predominately truncal , decreased . Quality of life ( QoL ) improved significantly in both rhGH groups . Fluid-retention adverse effects and hyperglycemia were more common in the DD than in the AD group . No significant changes in HIV viral load or CD4 cell count occurred . In conclusion , over the 12-week course of therapy , rhGH , 0.1 mg/kg DD , was superior to placebo in improving physical function , body weight , body composition , and QoL and was superior to AD dosing in restoring LBM Patients with acquired immunodeficiency syndrome ( AIDS ) often suffer from weight loss manifested by a loss of body cell mass ( BCM ) . The causes of human immunodeficiency virus (HIV)-associated wasting may include anorexia , malabsorption , and a variety of altered metabolic states . Malabsorption and diarrhea may result from gastrointestinal tract opportunistic infections or from direct effects of HIV on the gastrointestinal tract . Infection with HIV may produce metabolic derangements that alter nutrient utilization , result ing in loss of BCM . Nutritional assessment of the patient with AIDS should include an evaluation of BCM and physical and psychosocial functioning .  Antiretroviral therapy and eradication of opportunistic infections do not always reverse wasting . Treatment should include nutritional counseling . Total parenteral nutrition is sometimes of benefit , particularly in patients with damaged gastrointestinal tracts . Dronabinol and megestrol acetate may promote weight gain ; however , dronabinol may have adverse effects , and most of the gain with megestrol acetate is in fat rather than BCM . If gonadal dysfunction is present , testosterone replacement therapy should be included in the treatment plan . Some studies suggest that oral anabolic steroids may improve muscle strength and body composition . In r and omized , placebo-controlled trials , mammalian-derived human growth hormone ( rhGH[m ] ) has produced sustained weight and BCM gains in AIDS patients . If a patient continues to lose BCM after the above factors have been addressed and corrected , a 12-week course of rhGH[m ] is indicated . Halting the progression of HIV-associated wasting may improve survival , enhance physical and social functioning , and enrich quality of life Hypogonadism is prevalent among human immunodeficiency virus-infected men , in whom significantly reduced quality of life and mood disturbances have been reported . Previous studies have not investigated the relationship between depression score and gonadal function among such patients . We first compared depression scores in  hypogonadal ( n = 52 ) and eugonadal ( n = 10 ) patients with acquired immunodeficiency syndrome ( AIDS ) wasting , matched for weight and disease status , and then investigated the effects of testosterone administration on depression score in a r and omized , double-blind , placebo-controlled study among the group of hypogonadal men with AIDS wasting . The primary end point in all comparisons was the Beck Depression Inventory .  Hypogonadal patients demonstrated significantly increased scores on the Beck inventory compared with eugonadal- , age- , weight- , and disease status-matched subjects ( 15.5+/-1.1 vs. 10.6+/-1.4 mean + /- SEM , P = 0.02 ) . Among the combined hypogonadal and eugonadal subjects , a significant inverse correlation was seen between the Beck score and both free ( r = 0.41 , P<0.01 ) and total serum testosterone levels ( r = -0.43 , P<0.001 ) . The relationship between the Beck score and testosterone levels remained highly significant , controlling for weight , viral load , CD4 count , and antidepressant use ( P<0.01 for free testosterone , P<0.001 for total testosterone ) . Furthermore , when subjects were divided into two groups , based on a Beck score greater than 18 or less than or equal to 18 , serum total and free testosterone levels were significantly lower in the subjects with a Beck score greater than 18 , whereas there were no differences in weight , viral load , CD4 count , or Karnofsky status . End of study data were available in 39 patients who completed the r and omized , placebo-controlled study . Beck score decreased significantly only in the subjects receiving testosterone ( -5.8+/-1.3 , P < 0.001 ) , but not in subjects r and omized to placebo ( -2.7+/-1.3 , P > 0.05 ) . In a regression analysis , the change in Beck score was related significantly to change in weight ( P<0.01 ) . These data demonstrate increased depression score in association with hypogonadism in men with AIDS wasting , independent of weight , virologic status , and other disease factors . In such patients , administration of testosterone results in a significant improvement in depression inventory score . This effect may be a direct effect of testosterone or related to positive effects of testosterone on weight and /or other anthropometric indices . Additional studies are needed to assess the effects of testosterone on clinical depression indices in human immunodeficiency virus-infected patients Serum testosterone concentrations are frequently in the low-normal range ( lowest quartile , < 500 ng/dl ) in men with AIDS-wasting syndrome ( AWS ) and in other chronic wasting disorders . The response of patients in this group to and rogen treatment has not been determined , however . Eighteen men with AWS ( mean + /- st and ard error [ SE ] : 87 % + /- 1 % usual body weight ; CD4 count 90 + /- 24 ) and borderline low serum testosterone concentrations ( 382 + /- 33 ng/dl ) completed a 21-day placebo-controlled inpatient metabolic ward study comparing intramuscular ( i.m . ) placebo ( n = 7 ) with low-dose ( 65 mg/week ; n = 4 ) and high-dose ( 200 mg/week ; n = 7 ) n and rolone decanoate , a testosterone analogue .  Nitrogen balance , stable isotope-mass spectrometric measurement of de novo lipogenesis ( DNL ) , resting energy expenditure , and gonadal hormone levels were measured . Both low-dose and high-dose n and rolone result ed in significant nitrogen retention ( 33 - 52 g nitrogen/14 days , representing gains of 0.5 to 0.9 kg lean tissue/week ) compared with placebo ( loss of 11 g nitrogen/week ) . This was reflected biochemically in a borderline significant reduction of high DNL ( p < .06 ) . Serum testosterone and gonadotropins were suppressed whereas resting energy expenditure was unchanged by n and rolone treatment . In 10 study subjects completing a 12-week open-label follow-up phase , body weight increased by 4.9 + /- 1.2 kg , including 3.1 + /- 0.5 kg lean body mass , and treadmill exercise performance also improved . In summary , n and rolone decanoate therapy in the absence of an exercise program in borderline hypogonadal men with AWS caused substantial nitrogen retention compared with placebo , similar in extent to the nitrogen retention previously achieved with recombinant growth hormone . It is reasonable to exp and the criteria for and rogen treatment in AWS to include at least patients in the lowest quartile of serum testosterone To analyze the long-term survival factors associated with HIV infection , a prospect i ve follow-up study of 165 HIV-infected patients was performed after a clinical , nutritional , and biological evaluation . Survival rate could be determined in 129 patients after a follow-up of 42 mo before the use of protease inhibitors .  After univariate analysis , multivariate analysis was performed with the Cox regression proportional-hazard model . Survival curves were calculated and compared with the Kaplan , Meier , and log-rank tests . The study also analyzed the factors associated with impaired nutritional status at the beginning of the study and their effects on the long-term follow-up . Factors that could explain body weight loss before the study were the level of intakes , resting energy expenditure , chronic diarrhea , and the number of previous opportunistic infections . In the long-term follow-up , univariate analysis showed that nutritional status could be separated into four classes of body weight loss ( BWL ) by degree of loss ( BWL < or = 5 % , 5 % < BWL < or = 10 % , 10 % < BWL < or = 20 % , BWL > 20 % ) ; lean body mass ( adjusted to height ) , body cell mass , CD4 count , albumin , prealbumin , and C-reactive protein ( CRP ) were all significant predictors . Age , stage of disease , number of previous opportunistic infections , and antiviral therapies were not associated with a change in survival . With the multivariate model , only CD4 counts , lean body mass/height squared , and CRP remained significant independent predictors of survival after controlling for other factors BACKGROUND The prevalence of human immunodeficiency virus ( HIV ) disease is increasing among women , many of whom remain symptomatic with low weight and poor functional status . Although and rogen levels may often be reduced in such patients , the safety , tolerability , and efficacy of testosterone administration in this population remains unknown . METHODS A total of 57 HIV-infected women with free testosterone levels less than the median of the reference range and weight less than 90 % of ideal body weight or weight loss greater than 10 % were r and omly assigned to receive transdermal testosterone ( 4 mg/patch ) twice weekly or placebo for 6 months . Muscle mass was assessed by urinary creatinine excretion . Muscle function was assessed by the Tufts Quantitative Muscle Function Test . Treatment effect at 6 months was determined by analysis of covariance . Results are mean + /- SEM unless otherwise specified . RESULTS At baseline , subjects were low weight ( body mass index [ calculated as weight in kilograms divided by the square of height in meters ] 20.6 + /- 0.4 ) , with significant weight loss from pre-illness maximum weight ( 18.7 % + /- 1.2 % ) , and demonstrated reduced muscle function ( upper and lower extremity muscle strength , 83 % and 67 % , respectively , of predicted range ) . Testosterone treatment result ed in significant increases in testosterone levels vs placebo ( total testosterone : 37 + /- 5 vs -2 + /- 2 ng/dL [ 1.3 + /- 0.2 vs -0.1 + /- 0.1 nmol/L ] [ P<.001 ] ; free testosterone : 3.7 + /- 0.5 vs -0.4 + /- 0.3 pg/mL [ 12.8 + /- 1.7 vs -1.4 vs 1.0 pmol/L ] [ P<.001 ] ) and was well tolerated , without adverse effects on immune function , lipid and glucose levels , liver function , or body composition or the adverse effect of hirsutism . Muscle mass tended to increase ( 1.4 + /- 0.6 vs 0.3 + /- 0.8 kg ; P = .08 ) , and shoulder flexion ( 0.4 + /- 0.3 vs -0.5 + /- 0.3 kg ; P = .02 ) , elbow flexion ( 0.3 + /- 0.4 vs -0.7 + /- 0.4 kg ; P = .04 ) , knee extension ( 0.2 + /- 1.0 vs -1.7 + /- 1.3 kg ; P = .02 ) , and knee flexion ( 0.7 + /- 0.5 vs 0.3 + /- 0.7 kg ; P = .04 ) increased in the testosterone-treated compared with the placebo-treated subjects . CONCLUSIONS Testosterone administration is well-tolerated and increases muscle strength in low-weight HIV-infected women .  Testosterone administration may be a useful adjunctive therapy to maintain muscle function in symptomatic HIV-infected women This study was undertaken to determine if human recombinant growth hormone ( hrGH , 6 mg/d for 2 wk ) would stimulate muscle protein synthesis in AIDS wasting . Healthy controls were compared with patients who were HIV+ , had A 
    Output:
    
The 3 treatments for HIV wasting assessed -- rhGH , testosterone , and anabolic steroids -- all demonstrated significant efficacy in increasing LBM as compared with placebo .
Although meta- analysis did not indicate any statistically significant differences between these agents in the degree of efficacy in this outcome , the Food and Drug Administration-approved dose of rhGH may have advantages over the other 2 therapies in terms of improvements in functional capacity and