1
|
Essafi MA, Elazizi L, Aynaou H, Salhi H, El Ouahabi H. Reversible Gynecomastia in HIV-Infected Man Treated With Triple Antiretroviral Therapy Containing Efavirenz: A Case Report. Cureus 2022; 14:e27991. [PMID: 36120227 PMCID: PMC9469751 DOI: 10.7759/cureus.27991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/16/2022] Open
Abstract
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). After one year, the patient presented in the Department of Endocrinology, Diabetology, Metabolic Diseases, and Nutrition of Hassan II University Hospital Center, Fez, with bilateral gynecomastia. Hormonal exploration did not reveal any abnormality, so the gynecomastia was attributed to efavirenz use. The regimen was replaced by tenofovir, lamivudine, and dolutegravir. The gynecomastia was resolved within two months of discontinuing efavirenz. In summary, we think that secondary gynecomastia should be suspected and screened in HIV patients receiving efavirenz-containing regimens.
Collapse
|
2
|
Osman S, Mansoor E, Buccimazza I. Gynaecomastia in the Durban Breast Unit: A Comparison of HIV- and Non-HIV-Infected Individuals. World J Surg 2021; 44:1538-1546. [PMID: 31897689 DOI: 10.1007/s00268-019-05350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The clinical profile of gynaecomastia patients, both in human immunodeficiency virus (HIV)-positive and HIV-negative patients, in resource-limited settings remains largely undocumented. The aim of this study was to compare and contrast these groups with a view to developing an appropriate treatment algorithm for the South African population. METHODS A retrospective chart review at the Durban Breast Unit for the period 2000-2015 was undertaken with ethics approval [BE012/16 (sub-study of BCA173/15)]. Statistical analysis was done with IBM SPSS version 25. A p value <0.05 indicated statistical significance. RESULTS One hundred and four patients were documented. The mean age was 37 years. Gynaecomastia was most commonly attributed to puberty, HAART, other medications or an idiopathic aetiology. HIV status was known in 49 patients. There was a 97% prevalence of HAART use in the HIV-positive subgroup (n = 31). Efavirenz was the most common inciting drug. Incidence of gynaecomastia correlated with duration of HAART use. Age, late presentation, advanced Simon grade and bilateral disease appear to necessitate surgical intervention more frequently. CONCLUSION Patients on HAART are advised to seek early advice upon noticing gynaecomastia. Drug cessation/change is likely to assist only upon early presentation resulting in static progression, and ultimate cure would still entail surgical excision. Extensive blood and imaging studies should be done only where clinically indicated and can be considered in cases of recurrence post-surgery. Management option must be discussed with patients, and surgeons are required to be familiar with the various surgical techniques necessary to treat gynaecomastia.
Collapse
Affiliation(s)
- Safeeya Osman
- Durban Breast Unit (Inkosi Albert Luthuli Hospital and Addington Hospital), Durban, South Africa.
| | - E Mansoor
- Durban Breast Unit (Inkosi Albert Luthuli Hospital and Addington Hospital), Durban, South Africa
| | - I Buccimazza
- Durban Breast Unit (Inkosi Albert Luthuli Hospital and Addington Hospital), Durban, South Africa
| |
Collapse
|
3
|
Nel J, Dlamini S, Meintjes G, Burton R, Black JM, Davies NECG, Hefer E, Maartens G, Mangena PM, Mathe MT, Moosa MY, Mulaudzi MB, Moorhouse M, Nash J, Nkonyane TC, Preiser W, Rassool MS, Stead D, van der Plas H, van Vuuren C, Venter WDF, Woods JF. Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update. South Afr J HIV Med 2020; 21:1115. [PMID: 33101723 PMCID: PMC7564911 DOI: 10.4102/sajhivmed.v21i1.1115] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/21/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jeremy Nel
- Helen Joseph Hospital, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Sipho Dlamini
- Department of Infectious Diseases, Faculty of Medicine, University of Cape Town, Cape Town, South Africa
| | - Graeme Meintjes
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Rosie Burton
- Southern African Medical Unit, Médecins Sans Frontières (MSF), Cape Town, South Africa
| | - John M Black
- Department of Medicine, Division of Infectious Diseases, Livingstone Tertiary Hospital, Port Elizabeth, South Africa
| | | | - Eric Hefer
- Private Practice Medical Adviser, Johannesburg, South Africa
| | - Gary Maartens
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Phetho M Mangena
- Department of Internal Medicine, School of Medicine, Pietersburg Hospital, Polokwane, South Africa.,Department of Medicine, School of Medicine, University of Limpopo, Turfloop, South Africa
| | | | - Mahomed-Yunus Moosa
- Department of Infectious Diseases, Division of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa
| | | | - Michelle Moorhouse
- Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Nash
- Specialist Family Physician, Amathole District Clinical Specialist Team, East London, South Africa
| | - Thandeka C Nkonyane
- Department of Infectious Diseases, Faculty of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Medicine, Dr George Mokhari Hospital, Pretoria, South Africa
| | - Wolfgang Preiser
- Department of Medical Virology, National Health Laboratory Service, Tygerberg, South Africa.,Department of Pathology, Faculty of Medicine and Health, Stellenbosch University, Cape Town, South Africa
| | - Mohammed S Rassool
- Clinical HIV Research Unit, Wits Health Consortium, Johannesburg, South Africa
| | - David Stead
- Department of Medicine, Faculty of Infectious Diseases, Frere and Cecilia Makiwane Hospitals, East London, South Africa.,Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Helen van der Plas
- Department of Infectious Diseases, Faculty of Medicine, University of Cape Town, Cape Town, South Africa
| | - Cloete van Vuuren
- Department of Internal Medicine, Military Hospital, Bloemfontein, South Africa.,Department of Internal Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Willem D F Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joana F Woods
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
4
|
Biagi MJ, Schriever CA, Chiampas TD, Michienzi SM, Patel MC, Young JD, Badowski ME. Development of gynecomastia following initiation of bictegravir/emtricitabine/tenofovir alafenamide. Int J STD AIDS 2020; 31:380-382. [PMID: 32041480 DOI: 10.1177/0956462419895665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is a recently approved single-tablet antiretroviral regimen and is recommended as a first-line agent. No cases of gynecomastia were reported in clinical trials. We report development of ultrasound-confirmed gynecomastia in a previously antiretroviral-naïve patient approximately two months after starting BIC/FTC/TAF, which resolved ten weeks after discontinuing bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) based therapy.
Collapse
Affiliation(s)
- M J Biagi
- College of Pharmacy, University of Illinois at Chicago, Rockford, IL, USA
| | - C A Schriever
- College of Pharmacy, University of Illinois at Chicago, Rockford, IL, USA
| | - T D Chiampas
- Infectious Diseases Pharmacotherapy Section, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - S M Michienzi
- Infectious Diseases Pharmacotherapy Section, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - M C Patel
- Section of Infectious Diseases, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - J D Young
- Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - M E Badowski
- Infectious Diseases Pharmacotherapy Section, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
5
|
Shawarira-Bote S, Shamu T, Chimbetete C. Gynecomastia in HIV-positive adult men receiving efavirenz-based antiretroviral therapy at Newlands clinic, Harare, Zimbabwe. BMC Infect Dis 2019; 19:715. [PMID: 31409277 PMCID: PMC6693125 DOI: 10.1186/s12879-019-4332-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 07/29/2019] [Indexed: 11/20/2022] Open
Abstract
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/mm3 (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.
Collapse
|
6
|
Venter WDF, Kambugu A, Chersich MF, Becker S, Hill A, Arulappan N, Moorhouse M, Majam M, Akpomiemie G, Sokhela S, Poongulali S, Feldman C, Duncombe C, Ripin DHB, Vos A, Kumarasamy N. Efficacy and Safety of Tenofovir Disoproxil Fumarate Versus Low-Dose Stavudine Over 96 Weeks: A Multicountry Randomized, Noninferiority Trial. J Acquir Immune Defic Syndr 2019; 80:224-233. [PMID: 30640204 PMCID: PMC6358196 DOI: 10.1097/qai.0000000000001908] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/15/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Reducing doses of antiretroviral drugs, including stavudine (d4T), may lower toxicity, while preserving efficacy. There are substantial concerns about renal and bone toxicities of tenofovir disoproxil fumarate (TDF). SETTING HIV-1-infected treatment-naive adults in India, South Africa, and Uganda. METHODS A phase-4, 96-week, randomized, double-blind, noninferiority trial compared d4T 20 mg twice daily and TDF, taken in combination with lamivudine (3TC) and efavirenz (EFV). The primary endpoint was the proportion of participants with HIV-1 RNA <50 copies per milliliter at 48 weeks. Adverse events assessments included measures of bone density and body fat. The trial is registered on Clinicaltrials.gov (NCT02670772). RESULTS Between 2012 and 2014, 536 participants were recruited per arm. At week 96, trial completion rates were 75.7% with d4T/3TC/EFV (n = 406) and 82.1% with TDF/3TC/EFV (n = 440, P = 0.011). Noncompletion was largely due to virological failure [6.2% (33) with d4T/3TC/EFV versus 5.4% (29) with TDF/3TC/EFV; P = 0.60]. For the primary endpoint, d4T/3TC/EFV was noninferior to TDF/3TC/EFV (79.3%, 425/536 versus 80.8% 433/536; difference = -1.49%, 95% CI: -6.3 to 3.3; P < 0.001). Drug-related adverse event discontinuations were higher with d4T (6.7%, 36), than TDF (1.1%, 6; P < 0.001). Lipodystrophy was more common with d4T (5.6%, 30) than TDF (0.2%, 1; P < 0.001). Creatinine clearance increased in both arms, by 18.1 mL/min in the d4T arm and 14.2 mL/min with TDF (P = 0.03). Hip bone density measures, however, showed greater loss with TDF. CONCLUSIONS Low-dose d4T combined with 3TC/EFV demonstrated noninferior virological efficacy compared with TDF/3TC/EFV, but mitochondrial toxicity remained high. Little renal toxicity occurred in either arm. Implications of bone mineral density changes with TDF warrant investigation.
Collapse
Affiliation(s)
- Willem Daniel Francois Venter
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew Kambugu
- Infectious Diseases, College of Health Sciences at Makerere University, Kampala, Uganda
| | - Matthew F. Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Andrew Hill
- Pharmacology Department, University of Liverpool, Liverpool, United Kingdom
| | - Natasha Arulappan
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle Moorhouse
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammed Majam
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Godspower Akpomiemie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simiso Sokhela
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Selvamuthu Poongulali
- Chennai Antiviral Research and Treatment Clinical Research Site, YRGCARE Medical Centre, Voluntary Health Services, Chennai, India
| | - Charles Feldman
- Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Alinda Vos
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site, YRGCARE Medical Centre, Voluntary Health Services, Chennai, India
| |
Collapse
|
7
|
Bilateral Mastectomy as Radical Treatment of Gynecomastia Secondary to Antiretroviral Therapy in a Low-Income Setting: A Case Report. DRUG SAFETY - CASE REPORTS 2018; 5:21. [PMID: 29752634 PMCID: PMC5948190 DOI: 10.1007/s40800-018-0085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Gynecomastia is a common finding in males, with an incidence that varies widely globally. In 10–25% of cases, it is caused by drugs. Its pathophysiologic mechanism includes exposure to exogenous estrogens and medications that cause hypogonadism, antiandrogenic effects and hyperprolactinemia. Gynecomastia is associated with exposure to antiretroviral therapy (ART), particularly efavirenz. Sometimes surgery may be required as treatment. We report a case of a 46-year-old man receiving ART presenting with a marked bilateral breast enlargement who underwent bilateral mastectomy as the only successful treatment in a low-income setting.
Collapse
|
8
|
Meintjes G, Moorhouse MA, Carmona S, Davies N, Dlamini S, van Vuuren C, Manzini T, Mathe M, Moosa Y, Nash J, Nel J, Pakade Y, Woods J, Van Zyl G, Conradie F, Venter F. Adult antiretroviral therapy guidelines 2017. South Afr J HIV Med 2017; 18:776. [PMID: 29568644 PMCID: PMC5843236 DOI: 10.4102/sajhivmed.v18i1.776] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in 2014 and the update on when to initiate antiretroviral therapy in 2015. Since the release of the previous guidelines, the scale-up of antiretroviral therapy (ART) in southern Africa has continued. New antiretroviral drugs have become available with improved efficacy, safety and robustness. The guidelines are intended for countries in the southern African region, which vary between lower and middle income.
Collapse
Affiliation(s)
- Graeme Meintjes
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | | | - Sergio Carmona
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | - Natasha Davies
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | - Sipho Dlamini
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | | | | | - Moeketsi Mathe
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | - Yunus Moosa
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | - Jennifer Nash
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | - Jeremy Nel
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | - Yoliswa Pakade
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | - Joana Woods
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | - Gert Van Zyl
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| | | | - Francois Venter
- Southern African HIV Clinicians Society, Johannesburg, South Africa
| |
Collapse
|
9
|
Antivirals and Male Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1034:163-178. [DOI: 10.1007/978-3-319-69535-8_11] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|