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Dunlop JL, Slemming W, Schnippel K, Makura C, Levin LJ, Rayne S, Vujovic M, Firnhaber C. Breast abnormalities in adolescents receiving antiretroviral therapy. South Afr J HIV Med 2019; 20:1017. [PMID: 31745435 PMCID: PMC6852609 DOI: 10.4102/sajhivmed.v20i1.1017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/30/2019] [Indexed: 11/04/2022] Open
Abstract
Background Antiretrovirals, 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). Objectives The aim of this article was to examine the extent of breast abnormalities in adolescents receiving ART and determine any clinical associations. Methods A 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. Results Of 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). Conclusion Of 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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Affiliation(s)
- Jackie L Dunlop
- Right to Care, Johannesburg, South Africa.,Division of Child Health, School of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Wiedaad Slemming
- Division of Child Health, School of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathryn Schnippel
- Right to Care, Johannesburg, South Africa.,Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Sarah Rayne
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Cynthia Firnhaber
- Right to Care, Johannesburg, South Africa.,School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.,School of Internal Medicine, University of Colorado, Aurora, United States
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Silva BF, Peixoto G, da Luz SR, de Moraes S, Peres SB. Adverse effects of chronic treatment with the Main subclasses of highly active antiretroviral therapy: a systematic review. HIV Med 2019; 20:429-438. [PMID: 31006976 DOI: 10.1111/hiv.12733] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of the review was to elucidate the adverse effects of chronic treatment with the main subclasses of highly active antiretroviral therapy (HAART). METHODS A systematic review was carried out using the methods recommended in the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). Searches of articles in MEDLINE, SCIELO, Web of Science and LILACS were conducted from January to October 2018 based on the following descriptors and keywords: 'HIV' [AND]; 'AIDS' [OR]; 'HAART' [AND]; 'Highly Active Antiretroviral Therapy' [OR]; 'Adverse Effects' [AND]. All articles selected described the biochemical changes produced by, and the main adverse effects of, using one or more of the following HAART subclasses: nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs) and other new drugs. The selected articles included patients living with HIV (PLWH) initiating or continuing any type of HAART. The results are presented qualitatively and discussed. RESULTS Twenty-one articles found in the searches were selected for the review, and they included a total of 5626 participants. Seven of the studies investigated mainly NRTIs, three studies mainly NNRTIs, eight studies predominantly PIs, and three studies other antiretroviral drugs as the main treatment. The most common adverse effects on biochemical parameters were the emergence of anaemia for NRTIs as well as NNRTIs and PIs, and plasma lipid alterations caused by their prolonged use. In general, it was found that biological differences among individuals can cause differences in adverse effects, such as virological and treatment failure. CONCLUSIONS One or more occurrences of adverse effects of the chronic utilization of drugs were found for all subclasses of HAART, and certain combinations of drugs from different subclasses were also found to be associated with adverse events.
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Affiliation(s)
- B F Silva
- Adipose Tissue Research Group, Department of Physiological Sciences, State University of Maringá, Maringá, Brazil
| | - Gml Peixoto
- Department of Physiological Sciences, State University of Maringá, Maringá, Brazil
| | - S R da Luz
- Adipose Tissue Research Group, Department of Physiological Sciences, State University of Maringá, Maringá, Brazil
| | - Smf de Moraes
- Adipose Tissue Research Group, Department of Physiological Sciences, State University of Maringá, Maringá, Brazil
| | - S B Peres
- Adipose Tissue Research Group, Department of Physiological Sciences, State University of Maringá, Maringá, Brazil
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Saka B, Akakpo AS, Bassowa A, Dapam AN, Mahamadou G, Teclessou JN, Mouhari-Toure A, Laouali AY, Mensah E, Kombaté K, Pitché P. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)-induced Stevens-Johnson syndrome and gynecomastia in an HIV-infected child: A case report. Ann Dermatol Venereol 2018; 145:773-776. [PMID: 30301570 DOI: 10.1016/j.annder.2018.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 03/14/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are antiretroviral drugs often used in the first-line treatment regimen of HIV1 infection worldwide. We report a case of successive gynecomastia and Stevens-Johnson syndrome (SJS) respectively induced by efavirenz and nevirapine in a single patient. CASE REPORT A 16-year-old boy, HIV1-infected since birth, was started on antiretroviral treatment (ART) in August 2015 and was taking a regimen comprising abacavir, lamivudine and efavirenz. In April 2016, when his weight reached 35kg, abacavir was replaced with tenofovir. Bilateral breast enlargement, previously hidden by the patient, was diagnosed two years after the start of ART. History-taking, physical examination and laboratory tests ruled out known causes of gynecomastia, and efavirenz was thus considered the most likely cause. This drug was then withdrawn and replaced with nevirapine in July 2017. Thirty-three days after the patient started nevirapine treatment, a skin rash appeared. Physical examination revealed erythematous macules and flaccid bullae with estimated skin detachment of 10%. There were also conjunctival, buccal and genital lesions. A diagnosis was made of SJS induced by nevirapine. Three months after withdrawal of efavirenz, breast size decreased by 3cm on the left breast and 2cm on the right breast; two months after the SJS, cutaneous sequelae alone persisted, such as diffuse hyperchromic macules. DISCUSSION Recognition of gynecomastia as a side-effect of efavirenz is important to allow the condition to be treated while it is still potentially reversible. Moreover, when efavirenz is replaced, a protease inhibitor should be preferred to nevirapine.
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Affiliation(s)
- B Saka
- Service de dermatologie et IST, CHU Sylvanus Olympio, BP 30785, Lomé, Togo.
| | - A S Akakpo
- Service de dermatologie et IST, CHU Sylvanus Olympio, BP 30785, Lomé, Togo
| | - A Bassowa
- Service de gynécologie et d'obstétrique, CHU Sylvanus Olympio, Lomé, Togo
| | - A N Dapam
- Association Espoir Vie Togo (EVT), Lomé, Togo
| | - G Mahamadou
- Service de dermatologie et IST, CHU Sylvanus Olympio, BP 30785, Lomé, Togo
| | - J N Teclessou
- Service de dermatologie et IST, CHU Sylvanus Olympio, BP 30785, Lomé, Togo
| | - A Mouhari-Toure
- Service de dermatologie et IST, CHU Sylvanus Olympio, BP 30785, Lomé, Togo
| | - A Y Laouali
- Service de dermatologie et IST, CHU Sylvanus Olympio, BP 30785, Lomé, Togo
| | - E Mensah
- Association Espoir Vie Togo (EVT), Lomé, Togo
| | - K Kombaté
- Service de dermatologie et IST, CHU Sylvanus Olympio, BP 30785, Lomé, Togo
| | - P Pitché
- Service de dermatologie et IST, CHU Sylvanus Olympio, BP 30785, Lomé, Togo
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Abstract
There are few data on gynecomastia in HIV-infected children. Within the UK/Ireland's national cohort, 56 of 1873 (3%) HIV-infected children had gynecomastia, of which 10 (0.5%) were severe. All 10 had received antiretroviral therapy for a median of 27.5 (21, 42) months; 4 of 10 had received efavirenz, 7 of 10 and 6 of 10 had received stavudine and/or didanosine respectively. Five were nonreversible, despite changing antiretroviral therapy, and required breast reduction surgery.
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Larru B, Eby J, Lowenthal ED. Antiretroviral treatment in HIV-1 infected pediatric patients: focus on efavirenz. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2014; 5:29-42. [PMID: 25937791 PMCID: PMC4412603 DOI: 10.2147/phmt.s47794] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI), used for the treatment of human immunodeficiency virus (HIV)-1 infection. Approved by the US Food and Drug Administration in 1998, its indication was recently extended to include children as young as 3 months of age. The World Health Organization and many national guidelines consider efavirenz to be the preferred NNRTI for first-line treatment of children over the age of 3 years. Clinical outcomes of patients on three-drug antiretroviral regimens which include efavirenz are as good as or better than those for patients on all other currently approved HIV medications. Efavirenz is dosed once daily and has pediatric-friendly formulations. It is usually well tolerated, with central nervous system side effects being of greatest concern. Efavirenz increases the risk of neural tube defects in nonhuman primates and therefore its use during the first trimester of pregnancy is limited in some settings. With minimal interactions with antituberculous drugs, efavirenz is preferred for use among patients with HIV/tuberculosis coinfection. Efavirenz can be rendered inactive by a single point mutation in the reverse transcriptase enzyme. Newer NNRTI drugs such as etravirine, not yet approved for use in children under the age of 6 years, may maintain their activity following development of efavirenz resistance. This review highlights key points from the existing literature regarding the use of efavirenz in children and suggests directions for future investigation.
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Affiliation(s)
- Beatriz Larru
- Department of Pediatrics, Division of infectious Diseases, Children's Hospital of Philadelphia, Philadelphia
| | - Jessica Eby
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia ; Villanova University, Villanova
| | - Elizabeth D Lowenthal
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia ; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA ; Department of Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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