Gynaecomastia in two men on stable antiretroviral therapy who commenced treatment for tuberculosis.
Gynaecomastia is a common clinical presentation that varies from benign presentations in stages of human development to hormonal pathology, mainly due to hepatic dysfunction, malignancy, and adverse pharmacologic effects. We describe the development of significant bilateral gynaecomastia after starting treatment for pulmonary tuberculosis (TB) in two males with WHO stage III Human Immunodeficiency Virus (HIV) infection on stable antiretroviral regimens. Emerging reports suggest that distinct hepatic impairment in efavirenz metabolism modulates oestrogenic activity, which may be potentiated by anti-tuberculosis therapy. Clinical application includes early recognition of efavirenz-induced gynaecomastia, especially after commencing tuberculosis treatment. To avoid decreased adherence resulting from the distressing side effect of gynecomastia, transition to an alternative ART regimen over the course of tuberculosis treatment should be considered.
Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
Jeremy D
JD
Kratz
Catholic University of Mozambique, Beira, Mozambique.
Ahmad Y
AY
El-Shazly
Catholic University of Mozambique, Beira, Mozambique.
Santos G
SG
Mambuque
Centro de Saude Sao Lucas, Beira, Mozambique.
Elpidio
E
Demetria
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Peter
P
Veldkamp
Division of General Internal Medicine, University of California San Francisco, San Francisco, California, USA.
Timothy S
TS
Anderson
D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D000995:Antitubercular Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy; D006177:Gynecomastia / Q000139:chemically induced* / Q000175:diagnosis; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D018894:Reverse Transcriptase Inhibitors