Page 325 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 7 Original Research

Breast abnormalities in adolescents receiving

antiretroviral therapy

Authors: Background: Antiretrovirals, particularly efavirenz (EFV), have been shown to cause breast
Jackie L. Dunlop abnormalities in adults. Little is known about the prevalence of these adverse effects among
1,2
Wiedaad Slemming 2
Kathryn Schnippel adolescents receiving antiretroviral therapy (ART).
1,3
Caroline Makura 1
Leon J. Levin 1 Objectives: The aim of this article was to examine the extent of breast abnormalities in
Sarah Rayne 4 adolescents receiving ART and determine any clinical associations.
Marnie Vujovic 1
Cynthia Firnhaber 1,5,6 Methods: A retrospective record review describing breast conditions in adolescents receiving
ART at three facilities in Johannesburg was conducted. Patients aged 10–19 years, who
Affiliations: presented from January to December 2014, were included in the study. Analyses were
1 Right to Care, Johannesburg, conducted to determine whether EFV was associated with increased breast conditions.
South Africa
Results: Of the 631 patient records reviewed, 37 (6%) had an abnormal breast event documented;
2 Division of Child Health, with 24/37 (65%) being male patients. Patients with abnormal breast conditions were 1.5 years
School of Paediatrics,
University of the older than patients with normal breast development (p < 0.0005). Forty-one abnormal breast
Witwatersrand, Johannesburg, events were observed in 37 patients, with 20 described as gynaecomastia or lipomastia (49%).
South Africa Of the 37 patients, 44% (n = 19) had concurrent generalised lipodystrophy. Of those with an
abnormal breast event, 71% of patients had CD4 counts > 500 cells/µL and were virologically
3 Health Economics Unit, suppressed (n = 29). Those on EFV had a significantly higher prevalence of breast abnormalities
School of Public Health and
Family Medicine, University of compared to other regimens ( p = 0.016).
Cape Town, Cape Town,
South Africa Conclusion: Of the studied patients, 6% had an abnormal breast condition. The use of EFV and
increased age were associated with breast abnormalities in this population. Further research is
4 Department of Surgery, needed to better understand the implications of this potential side effect.
University of the
Witwatersrand, Johannesburg, Keywords: adolescent; HIV; antiretroviral; gynaecomastia; breast.
South Africa

5 School of Clinical Medicine, Background
University of the
Witwatersrand, Johannesburg, The maturation of the HIV epidemic, including increased access to antiretroviral therapy (ART)
South Africa over the last 20 years, means that increasing numbers of HIV-infected children are entering into
adolescence. Growing numbers of adolescents on ART, both boys and girls, are reporting
6 School of Internal Medicine, 1
University of Colorado, Aurora, abnormalities of their developing, or already developed, breasts.
United States
During normal breast development, adolescent girls may develop an array of breast abnormalities,
Corresponding author: including breast hyperplasia or hypertrophy, breast pain, nipple discharge and masses. Juvenile
2
Jackie Dunlop,
[email protected] breast hyperplasia is defined as the uncontrolled overgrowth of breast tissue that occurs in
adolescent girls whose breasts develop normally during puberty, but fail to stop growing at the
Dates: appropriate time. Quantifying the problem presents difficulties, as there is a spectrum of changes
2
Received: 05 Aug. 2019 that may be observed. Breast development in boys may be physiological; however, this must be
Accepted: 30 Aug. 2019
Published: 06 Nov. 2019 differentiated from gynaecomastia with a pathological origin. The incidence of physiological
gynaecomastia ranges from 4% to 69% in adolescent boys who may have palpable breast tissue
during puberty. 3

Antiretrovirals (ARV), particularly efavirenz (EFV), have been shown to cause breast abnormalities
in adults. 4,5,6 Gynaecomastia in adult men and breast hyperplasia or hypertrophy in adult women
receiving EFV have been described; however, the same condition is not well explored in adolescents.
In the UK and Ireland’s National Collaborative HIV Paediatric Study cohort, 3% of adolescents
Read online: experienced gynaecomastia (n = 56/1873) and, of these, 10 patients presented with severe
Read online:
Scan this QR gynaecomastia, all of whom had current or previous exposure to stavudine (D4T), didanosine and/
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mobile device How to cite this article: Dunlop JL, Slemming W, Schnippel K, et al. Breast abnormalities in adolescents receiving antiretroviral therapy.
to read online. S Afr J HIV Med. 2019;20(1), a1017. https://doi.org/10.4102/sajhivmed.v20i1.1017
to read online.
Copyright: © 2019. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
http://www.sajhivmed.org.za 318 Open Access