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HIV-related Gynecomastia Follows Prolonged Antiretroviral Therapy
By
Will Boggs, MD
HIV-related
gynecomastia [excessive development of the male mammary glands]
develops mainly in men with preserved immunological status after
years of highly active antiretroviral therapy (HAART), according
to a report in the September issue of AIDS Research and Human
Retroviruses.
There
are no conclusive data implicating a specific antiretroviral drug
in the development of gynecomastia, the authors explain, and the
management of HIV-related gynecomastia is poorly defined.
Dr.
Vincent Soriano and colleagues from Instituto de Salud Carlos III,
Madrid, Spain describe the clinical features and treatment of 34
HIV-positive men with gynecomastia in what they call "the largest
series of gynecomastia reported in HIV-infected patients."
These
patients came from a cohort of 1400 HIV-positive men. Of these,
900 were receiving antiretroviral therapy, the authors report, for
an incidence of 2.4 cases per 100 patients receiving HAART per year.
The
mean CD4 cell count was 681 cells/microliter, the report indicates,
and plasma HIV RNA was below 50 copies/mL in 77% of the patients
with gynecomastia.
All
but 2 patients initially had unilateral gynecomastia, the researchers
note, but just over half later developed bilateral gynecomastia.
About 70% of the patients also had body shape changes characteristic
of the lipodystrophy syndrome.
"Hypertrophy
of glandular tissue in these patients may overlap with adipose accumulation
in other body locations as part of the lipodystrophy syndrome,"
Dr. Soriano told Reuters Health. "We are analyzing this association
in more detail."
Gynecomastia
resolved spontaneously in 20 of 21 patients followed for more than
a year, the report indicates. One patient received tamoxifen treatment
for prolonged, painful gynecomastia, the investigators report, but
he showed no improvement during 8 months of treatment.
Patients
had received HAART for a mean time of 39 months, the report indicates,
but there was no overrepresentation of any particular drug in the
men with gynecomastia.
"Gynecomastia
in HIV-positive patients tends to be bilateral, often resolves spontaneously
after several months, and seems to be associated with antiretroviral
therapy," Dr. Soriano concluded.
The
authors suggest that treatment be considered in an attempt to prevent
fibrosis in patients with long-standing gynecomastia. "Plastic
surgery has been considered and performed in some of our patients
with refractory, painful gynecomastia," Dr. Soriano added.
10/31/03
AIDS
Res Human Retrovir 2003;19:739-741.
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