Breast abnormalities in adolescents receiving antiretroviral therapy

Abstract

BackgroundAntiretrovirals, particularly efavirenz (EFV), have been shown to cause breast abnormalities in adults. Little is known about the prevalence of these adverse effects among adolescents receiving antiretroviral therapy (ART).ObjectivesThe aim of this article was to examine the extent of breast abnormalities in adolescents receiving ART and determine any clinical associations.MethodsA retrospective record review describing breast conditions in adolescents receiving ART at three facilities in Johannesburg was conducted. Patients aged 10–19 years, who presented from January to December 2014, were included in the study. Analyses were conducted to determine whether EFV was associated with increased breast conditions.ResultsOf the 631 patient records reviewed, 37 (6%) had an abnormal breast event documented; with 24/37 (65%) being male patients. Patients with abnormal breast conditions were 1.5 years older than patients with normal breast development (p < 0.0005). Forty-one abnormal breast events were observed in 37 patients, with 20 described as gynaecomastia or lipomastia (49%). Of the 37 patients, 44% (n = 19) had concurrent generalised lipodystrophy. Of those with an abnormal breast event, 71% of patients had CD4 counts > 500 cells/µL and were virologically suppressed (n = 29). Those on EFV had a significantly higher prevalence of breast abnormalities compared to other regimens (p = 0.016).ConclusionOf the studied patients, 6% had an abnormal breast condition. The use of EFV and increased age were associated with breast abnormalities in this population. Further research is needed to better understand the implications of this potential side effect.

Impact of efavirenz on hormone-positive breast cancer survival in women living with HIV

“…The relatively high systemic and renal tubular tenofovir exposures obtained with TDF may affect mitochondrial function in the renal tubules [1,2], resulting in estimated glomerular filtration rate (eGFR) decline and proteinuria [3,4]. If unrecognized, continued exposure to TDF may result in acute tubular injury and proximal renal tubulopathy (PRT, Fanconi syndrome), which is characterized by phosphate and glucose wasting as a result of reduced reabsorption of these solutes from the glomerular ultrafiltrate [1,5,6].…”

“…Interactions between EFV and estrogen have been documented [4]. Clinically, gynecomastia development in children and men taking EFV have been noted [5][6][7][8] which is thought to be due to EFV-induced estrogen receptor activation, as demonstrated through in-vitro studies [9,10]. No studies, however, have been conducted evaluating the in-vivo effects of EFV in hormonedependent malignancies, including breast cancer.…”