Efavirenz-associated Gynecomastia: Report of Five Cases

The prognosis of HIV infection has improved dramatically since the introduction of HAART. However, numerous adverse effects and limitations regarding tolerability remain a concern.

Lipomastia (pseudo-gynecomastia), a breast enlargement due to central adiposity, may occur as part of a fat redistribution syndrome that has been associated with HAART regimens. Several pathogenic mechanisms have been advocated in its development.

In the current observational longitudinal study, investigators report on five patients diagnosed with gynecomastia associated with efavirenz (Sustiva)-based HAART regimens.

• All cases reached successful immunologic and virologic responses to HAART.
• The delay of appearance of gynecomastia from the beginning of HAART ranged between 4 to 15 months.
• In all five cases, gynecomastia regressed after efavirenz withdrawal (mean period of 5 months).

In conclusion, the authors write, “In summary, we think that HAART induced gynecomastia should be suspected in HIV patients receiving efavirenz-containing regimens. Although pathogenesis is unclear, this study and a review of the English literature implicates two possible mechanisms: (a) immune restoration processes and (b) efavirenz mediated estradiol-like effects.

Infectious Diseases Division, Internal Medicine Department, Hospital of San Juan, Alicante, Spain.

05/12/04

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