AEGiS-15IAC: Gynecomastia associated with hypogonadism in HIV infected patients.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Gynecomastia associated with hypogonadism in HIV infected patients.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. ThOrB1357)

Blanco JL, Biglia A, Martinez E, Domingo P, Casamitjana R, Milinkovik A, Leon A, Garcia M, Murillas J, Laguno M, Lonca M, Larrousse M, Gatell JM
Hospital Clinic, Barcelona, Spain

BACKGROUND: The pathogenesis of gynecomastia in HIV-infected male adults is unclear.

METHODS: Consecutive HIV-infected male adults from two Barcelona(Spain) Hospitals were clinically evaluated for breast enlargement. Random asymptomatic controls without gynecomastia were also recruited in a 1:1 fashion. Gynecomastia was confirmed by sonography. In both cases and controls, clinical data (including age, body mass index, clinical lipoatrophy or lipoaccumulation, prior symptomatic hyperlactatemia, end-stage liver disease, antiretroviral and other mediations, marijuana use) were collected, and laboratory data including plasma HIV RNA, CD4 cells, hepatitis B and C serological test, triglycerides and cholesterol, and hormonal levels (prolactin, total and free testosterone (FT), sex-binding globulin, 17-b-estradiol, FSH, LH, TSH) were measured.

RESULTS: There were 44 cases of breast enlargement among 2275 HIV-infected male adults, but gynecomastia was confirmed in 40 (1.8%). Gynecomastia was bilateral in 20 (50%) cases. When cases were compared with controls, multivariate logistic regression analysis identified lipoatrophy (OR 5.6, 95% CI 1.7-18.6), hepatitis C infection (OR 6.1,95%CI: 1.8-20.6), and current d4T (OR 4.5, 95% CI 1.5-13.6) and current efavirenz (OR 7.6, 95% CI1.8-32.2) use as independent risk factors, but not total duration of exposure to any individual antiretroviral drugs. Free testosterone was significantly lower in cases (42.6±24) compared with controls (58±25.3, p=0.006), whereas the remaining endocrine parameters were similar. Prevalence of primary-low FT and high LH- (21.42% vs. 4.87%, p=0.034) and secondary-low FT and normal or low LH- (57.14% vs. 24.39%, p=0.0058) hypogonadism was higher in cases than in controls. Conclusion Our study suggests hypogonadism is the underlying mechanism associated with gynecomastia en HIV-infected male adults.

Keywords: AEGIS, HIV, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Gynecomastia, Hypogonadism, Prevalence, HIV Infections, Risk Factors, Infection, HIV-1, Testosterone, Anti-HIV Agents, HIV-Associated Lipodystrophy Syndrome, Oxazines, Acidosis, Lactic, Follicle Stimulating Hormone, Estradiol, Spain, efavirenz, Male, Adult, Humans

040711
ThOrB1357