Severe Gynecomastia in an African Boy With Perinatally Acquired Human Immunodeficiency Virus Infection Receiving Highly Active Antiretroviral Therapy

Dzwonek, Agnieszka B.; Clapson, Margaret; Withey, Stephen B.; Bates, Alan; Novelli, Vas

doi:10.1097/01.inf.0000200138.37519.5b

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…Cross-sectional data from the general population has shown that gynaecomastia occurs in 4% of adolescent boys aged 10–19 years [20]. There is limited data on ART-associated gynaecomastia in African children and adolescents [21, 22]. …”

Section: Discussionmentioning

confidence: 99%

Cases of antiretroviral-associated gynaecomastia reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa

et al. 2016

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BackgroundGynaecomastia is associated with exposure to antiretroviral therapy (ART), in particular efavirenz. There is limited data on clinical characteristics of patients with ART-associated gynaecomastia in resource-limited settings and little guidance on the optimal management of this adverse drug reaction (ADR). We describe the clinical characteristics, management and outcomes of gynaecomastia cases reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa.MethodsWe identified all gynaecomastia cases in adolescent boys and men on ART reported to the hotline between June 2013 and July 2014. We collected follow up data telephonically at monthly intervals to document clinical management and outcomes.ResultsWe received 51 reports of gynaecomastia between June 2013 and July 2014; 11% of the 475 patient-specific ADR queries to the hotline. All patients were on efavirenz-based ART. Mean age was 34 years (standard deviation 12) and seven were adolescents. The median onset of gynaecomastia was 15 months after efavirenz initiation (interquartile range 6–42). Gynaecomastia was bilateral in 29 patients (57%) and unilateral in 16 (31%). Serum testosterone was quantified in 25 of 35 patients with follow up data, and was low in 2 (8%). Efavirenz was replaced with an alternative antiretroviral in 29/35 patients (83%) and gynaecomastia improved in 20/29 (69%).ConclusionsGynaecomastia was a frequently reported ADR in our setting, occurring with prolonged efavirenz exposure. Testosterone was low in the minority of tested cases. Most clinicians elected to switch patients off efavirenz, and gynaecomastia improved in the majority.

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Section: Discussionmentioning

confidence: 99%

Cases of antiretroviral-associated gynaecomastia reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa

et al. 2016

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“…Gynecomastia was persistent despite withdrawal of efavirenz and eventually bilateral mastectomy was required. This case was an adolescent boy who already had gone through normal pubertal development before the development of bilateral gynecomastia [20]. Finally, a study from Uganda on occurrence of side-effects in children on ART reported one case of gynecomastia in a child taking zidovudine, lamivudine and efavirenz, but information on age, pubertal stage, follow-up and switch of regimen are not provided [21].…”

Section: Discussionmentioning

confidence: 99%

“…Socio-psychological affliction is another major reason to manage this side-effect intensively. Young children, especially boys, with breast development have been reported to suffer from cultural and social stigma [3,4,20,26,27]. In addition prepubertal children with gynecomastia may be considered sexually mature at too young an age.…”

Section: Discussionmentioning

confidence: 99%

Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report

et al. 2013

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BackgroundPrepubertal gynecomastia is a rare condition and most frequently classified as idiopathic. In HIV-infected adults gynecomastia is a recognised but infrequent side-effect of antiretroviral treatment (ART) and mostly attributed to efavirenz use. Gynecomastia should be distinguished from pseudogynecomastia as part of the lipodystrophy syndrome caused by Nucleoside Reverse Transcriptase Inhibitors (NRTIs) to avoid incorrect substitution of drugs. In the medical literature only five cases of prepubertal gynecomastia in children taking ART are described and underlying pathogenesis was unknown. The occurrence of adverse effects of ART may interfere with therapy adherence and long-term prognosis and for that reason requires attention. We report the first case of prepubertal gynecomastia in a young girl attributed to efavirenz use.Case presentationA seven-year-old African girl presented with true gynecomastia four months after initiation on ART (abacavir, lamivudine, efavirenz). History, physical examination and laboratory tests excluded known causes of gynecomastia and efavirenz was considered as the most likely cause. Six weeks after withdrawal of efavirenz the breast enlargement had completely resolved.ConclusionsEfavirenz-induced gynecomastia may occur in children as well as in adults. With the increasing access to ART, the possibility of efavirenz-exposure and the potential occurrence of its associated side-effects may be high. In resource-poor settings, empirical change from efavirenz to nevirapine may be considered, providing no other known or alarming cause is identified, as efavirenz-induced gynecomastia can resolve quickly after withdrawal of the drug. Timely recognition of gynecomastia as a side-effect of efavirenz is important in order to intervene while the condition may still be reversible, to sustain adherence to ART and to maintain the sociopsychological health of the child.

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“…7 In another case, a 15-year-old HIV-infected boy developed severe, bilateral breasts 2 years after changing to an EFV-containing regimen. 8…”

Section: Introductionmentioning

confidence: 99%

Breast abnormalities in adolescents receiving antiretroviral therapy

Dunlop

Slemming

Schnippel

et al. 2019

South. Afr. j. HIV med.

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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.

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Severe Gynecomastia in an African Boy With Perinatally Acquired Human Immunodeficiency Virus Infection Receiving Highly Active Antiretroviral Therapy

Cited by 6 publications

References 9 publications

Cases of antiretroviral-associated gynaecomastia reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa

Cases of antiretroviral-associated gynaecomastia reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa

Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report

Breast abnormalities in adolescents receiving antiretroviral therapy

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