Gynaecomastia in two men on stable antiretroviral therapy who commenced treatment for tuberculosis

Kratz, Jeremy D.; El-Shazly, Ahmad Y.; Mambuque, Santos G.; Demetria, Elpidio; Veldkamp, Peter; Anderson, Timothy S.

doi:10.4314/mmj.v28i4.8

Cited by 6 publications

(5 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In Malawi, a study on 1207 men found a prevalence of 6% with evidence of adverse psychological effects [9]. The majority of the cases were bilateral and this is consistent with studies done in Sub-Saharan-Africa [3, 4, 10]. Most cases (83%) resolved upon stopping efavirenz and this is in keeping with findings from case studies done in Malawi, South Africa and Mozambique [3, 4, 7].…”

Section: Discussionsupporting

confidence: 78%

Gynecomastia in HIV-positive adult men receiving efavirenz-based antiretroviral therapy at Newlands clinic, Harare, Zimbabwe

Shawarira–Bote¹,

Shamu²,

Chimbetete³

2019

BMC Infect Dis

View full text Add to dashboard Cite

Background Gynecomastia is known to occur in some men taking an efavirenz-based antiretroviral therapy (ART) regimen. However, the incidence and outcomes of gynecomastia are not known in Zimbabwe. We described the characteristics and outcomes of gynecomastia among male patients on an efavirenz-based ART regimen. Methods We conducted a retrospective cohort review of data of all male patients aged ≥18 years taking an efavirenz-based regimen at Newlands Clinic, Harare, Zimbabwe before 31 March 2017. The primary outcome was gynecomastia as defined by breast/nipple enlargement reported by patient and confirmed by clinical palpation. Routinely collected data on demographics, baseline CD4, body mass index, duration on efavirenz, clinical presentation and outcomes were extracted from the clinic database and analysed using STATA 12.1. We investigated for any associations with concomitant medicines using cox regression. Results We analysed data for 1432 men with a median age of 40 years (IQR: 33–48). Half of the patients were in WHO stage 1 at ART commencement. Median body mass index and CD4 count at efavirenz commencement was 21 (IQR: 19–23) and 260 cells/mm 3 (IQR: 126–412) respectively. The incidence of gynecomastia was 22/1000 person-years (IQR: 17.3–27.8). Over half of the cases (58%) were bilateral and 75% of all cases developed within two years of starting efavirenz. There were no significant associations with concomitant use of isoniazid (HR: 0.95, p = 0.87) or amlodipine (HR: 0.43, p = 0.24). Gynecomastia resolved in 83.5% of cases following withdrawal of efavirenz with a median time to resolution of 3 months (IQR: 2–9). Conclusion The incidence of gynecomastia among patients taking efavirenz-based ART was low with most cases developing early on during treatment. Most cases resolved completely after withdrawing efavirenz.

show abstract

Section: Discussionsupporting

confidence: 78%

Gynecomastia in HIV-positive adult men receiving efavirenz-based antiretroviral therapy at Newlands clinic, Harare, Zimbabwe

Shawarira–Bote¹,

Shamu²,

Chimbetete³

2019

BMC Infect Dis

View full text Add to dashboard Cite

show abstract

“…In the literature, the reported cases were bilateral and resolved upon discontinuation of efavirenz, similar to our patient (Table 1) [9,10,12,13,16,17]. The time of resolution in our case report was two months after the discontinuation of efavirenz, which is comparable to other studies that have reported a resolution time of three to 10 months [9,10,12,13,16,17].…”

Section: Discussionsupporting

confidence: 89%

“…In our case report, gynecomastia was attributed to efavirenz use. Some case reports and small case series have reported gynecomastia as a side effect of efavirenz [8][9][10][11][12][13]; the physio-pathological mechanism is unclear, but there are some hypotheses about estrogen hormone activation [11,14,15]. In an experimental study by Sikora et al [11] direct estrogenic effect of efavirenz was explained.…”

Section: Discussionmentioning

confidence: 99%

Reversible Gynecomastia in HIV-Infected Man Treated With Triple Antiretroviral Therapy Containing Efavirenz: A Case Report

Essafi¹,

Elazizi²,

Aynaou³

et al. 2022

Cureus

View full text Add to dashboard Cite

Gynecomastia is benign hypertrophy of male breast glandular tissue, either unilateral or bilateral, secondary to increased estrogen/testosterone ratio (elevated estrogen level, decreased testosterone levels, or both). The condition can be related to a medical disease or caused by some drugs.Since the introduction of triple antiretroviral therapy (TAT), we have seen an improvement in the prognosis of human immunodeficiency virus (HIV) infection.Here we report the case of a 53-year-old man receiving follow-up care in Internal Medicine for HIV infection receiving TAT (tenofovir/efavirenz/emtricitabine

show abstract

“…4 Although gynecomastia may be clinically benign, it is sometimes accompanied by underlying medical conditions. 5 This study examined a male patient with unilateral gynecomastia and hyponatremia, which were his dominant clinical symptoms, and he was diagnosed with adrenal insufficiency. With the manifestations of cortisol deficiency, low blood pressure, hyperpigmentation, and normal intracranial MRI, primary adrenal insufficiency may be suspected.…”

Section: Discussionmentioning

confidence: 99%

Treatment of gynecomastia with prednisone: case report and literature review

Jin¹,

Fan²

2019

J Int Med Res

View full text Add to dashboard Cite

This study aimed to report a unique case of primary adrenal insufficiency that was accompanied by painful gynecomastia, which was resolved by treatment with prednisone. Enlargement of the left breast with continuous weakness and generalized nausea in a male was discovered 3 months before admission. Magnetic resonance imaging of the brain was normal 1 month before presentation. A physical examination revealed that the diameter of the left breast was 5 cm and the height was 3 cm. Laboratory investigations revealed hyponatremia, with a low serum cortisol level and an elevated prolactin level. Hyperprolactinemia was suspected because of adrenal deficiency that was directly or indirectly associated with increased prolactin levels. Thus, a diagnosis of hyperprolactinemia was confirmed. Ultrasonography of the left breast showed glandular tissue hyperplasia. In the present study, treating adrenal insufficiency with prednisone relieved both gynecomastia and hyponatremia. However, gynecomastia regression and hyponatremia resolution were observed when prednisone was stopped. Gynecomastia completely resolved by re-administering prednisone. Therefore, treating the underlying disease is essential so that prednisone can be given in a timely manner.

show abstract

Gynaecomastia in two men on stable antiretroviral therapy who commenced treatment for tuberculosis

Cited by 6 publications

References 13 publications

Gynecomastia in HIV-positive adult men receiving efavirenz-based antiretroviral therapy at Newlands clinic, Harare, Zimbabwe

Gynecomastia in HIV-positive adult men receiving efavirenz-based antiretroviral therapy at Newlands clinic, Harare, Zimbabwe

Reversible Gynecomastia in HIV-Infected Man Treated With Triple Antiretroviral Therapy Containing Efavirenz: A Case Report

Treatment of gynecomastia with prednisone: case report and literature review

Contact Info

Product

Resources

About