{"id":27610,"date":"2014-12-01T08:14:27","date_gmt":"2014-12-01T08:14:27","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=27610"},"modified":"2014-12-01T10:06:37","modified_gmt":"2014-12-01T10:06:37","slug":"efavirenz-associated-gynaecomastia-reported-to-the-national-hiv-and-tb-healthcare-workers-hotline-in-south-africa","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/27610","title":{"rendered":"Efavirenz-associated gynaecomastia reported to the national HIV and TB healthcare workers hotline in South Africa"},"content":{"rendered":"

Polly Clayden, HIV i-Base<\/strong><\/p>\n

Efavirenz-associated gynaecomastia (benign proliferation of glanular breast tissue in males) has been frequently reported to the South African national HIV and TB healthcare workers hotline. Results from a study conducted to look at this phenomenon were presented at the 2014 Southern African Clinicians Society Conference.<\/strong><\/p>\n

Christine Njuguna from the Division of Clinical Pharmacology, University of Cape Town showed data from the study, which included likely gynaecomastia cases reported to the hotline between 1 June 2013 and 31 July 2014.<\/p>\n

Fifty-one cases were reported, which made up 11% of 469 adverse event queries during the study period. The mean age of the men and boys was 34 years (SD +\/- 12); 86% were adults >18 years and the remaining 14% were adolescents aged 10-17 years. Overall, the mean baseline CD4 count was 188 cells\/mm3 (SD +\/-94) and 51% of the cohort was virally suppressed <50 copies\/mL. Onset of gynaecomastia occurred and a median of 15 months (IQR 6-41) after ART initiation.<\/p>\n

All cases were receiving efavirenz-based regimens. Additional other drugs were suspected in 31% of cases: isoniazid (n=12), d4T (n=5) and amlodipine (n=1).<\/p>\n

Out of 51 cases, 35 (16%) were followed up for a median of 4 months (IQR 1-6). Testosterone was measured at follow up in 25\/35 (71%) of which 19 (76%) had normal and 2 (8%) had low levels. Efavirenz was switched in 29 (82%) cases, of which 16 had normal testosterone levels. The majority (n=27) switched to nevirapine and two cases switched to lopinavir\/ritonavir.<\/p>\n

Overall outcomes in 35 men and boys with follow up were: 7 (20%) resolved, 14 (40%) improved, 3 (8%) were unchanged and 11 (31%) unknown. The median time to improvement was 3 months (IQR 2-4, range 1-8).<\/p>\n

In conclusion Dr Njuguna noted that efavirenz-associated gynaecomastia was frequently reported to the hotline. Most cases had prolonged efavirenz exposure and normal testosterone. Seven cases were in adolescents for which data are sparse.<\/p>\n

She suggested that prospective studies are needed to look at: incidence and risk factors, the proportion associated with hypogonadism, optimal management (continue or stop efavirenz), including in puberty.<\/p>\n

Reference:<\/p>\n

Njuguna C et al. A case series of ART-associated gynaecomastia reported to the national HIV and TB healthcare workers (HCW) hotline. 2014 Southern African Clinicians Society Conference, 24-27 September 2014, Cape Town, South Africa.
\nhttp:\/\/sahivsoc2014.co.za\/wp-content\/uploads\/2014\/10\/Thurs_Christine_Njuguna-obwolo%20A%20case%20series%20of%20antiretroviral%20therapy.pdf<\/a> (PDF)<\/p>\n","protected":false},"excerpt":{"rendered":"

Polly Clayden, HIV i-Base Efavirenz-associated gynaecomastia (benign proliferation of glanular breast tissue in males) has been frequently reported to the South African national HIV and TB healthcare workers hotline. Results from a study conducted to look at this phenomenon were …<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,3,8],"tags":[196],"class_list":["post-27610","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-antiretrovirals","category-side-effects","tag-southern-african-clinicians-society-conference-2014"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/27610","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=27610"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/27610\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=27610"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=27610"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=27610"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}