HIV-related Gynecomastia Is Associated with Hypogonadism

Gynecomastia (male breast enlargement) in HIV-infected men is independently associated with hypogonadism, rather than an adverse effect of treatment, according to a report in the November 15th issue of Clinical Infectious Diseases.

Gynecomastia is occasionally reported in HIV-infected men, the authors explain, but hormonal studies of these patients are lacking.

Dr. Esteban Martinez of the University of Barcelona and colleagues studied the prevalence, risk factors, and potential hormonal abnormalities associated with gynecomastia in 2275 adult HIV-infected men followed at two referral centers.

Forty men were confirmed sonographically to have gynecomastia, the authors report, for a prevalence in their population of 1.8%.

In a multivariate logistic regression analysis, gynecomastia was associated with three independent factors: chronic hepatitis C, lipoatrophy, and current therapy with stavudine (d4T; Zerit) or efavirenz (Sustiva).

The mean free testosterone index was significantly lower and TSH levels were significantly higher among patients with gynecomastia, the report indicates, and hypogonadism was more common among patients with gynecomastia (67.5%) than among controls without gynecomastia (38.6%).

In the final multivariable model, hypogonadism was associated with a 7.6-fold higher risk of gynecomastia, compared with a 6.1-fold increased risk associated with chronic hepatitis C and a 5.6-fold increased risk associated with lipoatrophy.

"Gynecomastia among HIV-infected men is an uncommon condition with a prevalence similar to that reported in the general male population," the authors conclude. "In contrast, hypogonadism among HIV-infected adult men seems to be a condition that has been underestimated in frequency, and it was an independent factor associated with gynecomastia."

11/29/04

Clin Infect Dis 2004;39:1514-1519.