AEGiS-15IAC: Gynecomastia emerging during antiretroviral therapy. What correlations have been explored?

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Gynecomastia emerging during antiretroviral therapy. What correlations have been explored?

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. B10212)

Manfredi R, Calza L, Chiodo F
Infectious Diseases, University of Bologna, Bologna, Italy

BACKGROUND: Gynecomastia (G) is an emerging HAART adverse event.

METHODS: A cross-sectional survey of ~1000 HIV-infected patients (p) was aimed to identify all cases of G related to >1 year of HAART,and to investigate correlation with demographic-epidemiological variables,clinical-laboratory markers of HIV disease,prior-underlying anti-HIV therapy,metabolic abnormalities,and outcome. All p with ultrasonography-confirmed,true G,were considered after exclusion of conditions potentially involved in prompting this disorder: eventual concurrent metabolic alterations,including the lipodystrophy syndrome,dysmetabolism,and administered antiretrovirals were investigated.

RESULTS: 18 of 579 evaluable HIV-infected males (3.1%), developed G when aged 12-58 years. The duration of HIV infection and HAART varied significantly in our p group,and no correlation was found with clinical-laboratory markers of HIV disease,but 7 p of 18 never received protease inhibitors (PI),while an EFZ-based HAART apparently prompted G in 5 p who were naïve for PI,and worsened this sign in 2 more p who switched from PI. Two p developed G while on isolated dual nucleoside analogue (NA) therapy. Among NA,d4T represented the more frequently used drug,administered for a longer time (p<.01). A hormonal workout did not detect abnormalities (hypogonadism,hyperprolactinemia),in all p but one. A concurrent lipodystrophy was present in all the 18 p with G,while hypertriglyceridemia,hypercholesterolemia,and hyperglycemia were found in 13,7,and 3 p. During the 6-28-month follow-up,no improvement of gynecomastia was observed in 15 p of 18,despite eventual therapeutic changes,but surgery proved necessary in 1 p only,due to local discomfort.

CONCLUSION: The frequent association of G with other HAART-related metabolic anomalies suggests some common pathway with HIV- and antiretroviral-related disturbances,so that further investigation should be deserved to the role of single antiretroviral compounds,and their associations.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Gynecomastia, Lipodystrophy, HIV Infections, Stavudine, Acquired Immunodeficiency Syndrome, Hypertriglyceridemia, Drug Therapy, Combination, HIV-Associated Lipodystrophy Syndrome, HIV Seropositivity, Cross-Sectional Studies, Humans, Male, therapy, drug therapy

040711
B10212