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HIV infection, HAART, and gynecomastia. Epidemiological, clinical, and potential pathogenetic correlates

Abstract number: 1734_187

Manfredi R., Calza L.

Introduction: Gynecomastia (G) is an emerging untoward event in patients treated with HAART.

Patients and Methods: Through a cross-sectional study performed on around 1,000 HIV-infected patients (p) treated with antiretrovirals at our reference centre in Bologna (Italy), we identified all cases of G related to the administration of at least 12 consecutive months of HAART, to assess possible correlations of G with a spectrum of clinical, laboratory, and therapeutic variables (and including all adverse effects of HAART itself). All p with true G (as distinguished from lipomastia by an ultrasonography assay) were considered evaluable, while p with other predisposing conditions (endocrine disease, alcohol abuse, liver cirrhosis, and use of drug possibly predisposing to G), were carefully ruled out.

Results: Twenty-one out of 616 evaluable HIV-infected male p (3.4% of our p population), developed a true G when aged 12–58 years. Seven p out of 21 never received protease inhibitor (PI)-containing therapies, while efavirenz-based regimens apparently prompted G in 7 p who were naïve for PI, and worsened this disturbance in three further p who abandoned PI for efavirenz. Considering nucleoside analogues (NA), two p developed G during treatment conducted with dual isolated NA. Comparing the different administered NA, stavudine seemed to be the most commonly used compound, also taken for the longest time (p < 0.01). A complete hormonal workup did not detect significant abnormalities, save in one p, who had slight serum FHS, LH, and testosteron abnormalities (with normal prolactin levels). When considering the eventual correlation with the most common HAART-induced disturbances, some forms of lipodystrophy was concurrent in all the 21 p with G, while hypertriglyceridaemia, hypercholesterolaemia, and hyperglycaemia were found in 15, 9, and 3 p, respectively. During the subsequent 12–36-month follow-up, a spontaneous ameliorement of G was never observed, notwithstanding eventual HAART modifications. Due to local hypersthesia, tenderness, and discomfort, two p resorted to surgery.

Conclusions: G is probably an underestimated problem in the setting of HAART. The frequent association of G with other HAART-related dysmetabolism suggests a possible common pathogenetic causes.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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