Page 327 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 3 of 7 Original Research

TABLE 2: Demographic and clinical characteristics of patients with abnormal plotting one standard deviation above the mean, while
breast events (n = 41). approximately 5% (n = 2/41) were classified as thin, defined
Characteristic Description Count %
Age at breast event < 10 years 2 4.9 as plotting two standard deviations below the mean. The
10–15 years 28 68.3 other 83% had a normal BMI (n = 34/41).
> 15 years 11 26.8
Years on ART from initiation < 1 3 7.3 Association of breast abnormalities to
to breast event
1 8 19.5 patient characteristics and prescribed
2 2 4.9 antiretroviral therapy
3 3 7.3
≥ 4 25 61.0 Table 3 shows the characteristics of those patient files that
Years on regimen leading < 1 7 17.1 had documented abnormal breast events compared to files
to breast event
1 12 29.3 that had normal breast development or no mention of breast
2 6 14.6 conditions. Patient age, at the latest visit in the study period,
3 5 12.2 with breast abnormalities was significantly older than the
≥ 4 11 26.8 group with normal breasts (p < 0.0005). Furthermore, a
CD4 count at breast event < 200 4 9.8
(cells/µL)† significantly higher percentage of boys (7.9%) than girls
200–500 8 19.5
500–1000 21 51.2 (4.0%) had abnormal breast conditions (p = 0.043).
> 1000 8 19.5
HIV-1 viral load at breast Undetectable (< 50) 29 70.7 The different associations of ART drugs prescribed in those with

event (copies/mL)† Viral load 50–1000 10 24.4 abnormal breasts versus those presumed to be developing
Viral load > 1000 2 4.9 normally are displayed in Table 3. In both groups, most patients
Age-related BMI (kg/m ) Underweight (< −2 s.d.) 12 29.2 were receiving abacavir with lamivudine (3TC) as their
2
Normal (−2 to 1 s.d.) 21 51.2 nucleoside reverse transcriptase inhibitor (NRTI) backbone.
Overweight (> 1 s.d.) 8 19.5
Description of breast‡ Enlargement 18 43.9
Breast buds 2 4.9 A significantly greater proportion of patients with
Gynaecomastia 12 29.2 abnormalities were receiving EFV (n = 34/37; 91.2%)
Lipomastia 4 9.8 compared to those with normal breasts (n = 384/594; 64.6%)
Gynaecomastia or Lipomastia 3 7.3 (p = 0.016). Of the remaining three events, two abnormal
Breast lump 1 2.4 breast events occurred on lamivudine monotherapy and the
None recorded 1 2.4 third one occurred on another NRTI-only holding regimen.
Severity of breast Early and small 2 4.9 The prevalence in these three cases was 4.3% and was non-
condition§ Moderate or mild 11 26.8
Severe or very large 3 7.3 significantly lower than the overall prevalence of abnormal
None recorded 25 61.0 breast events in the cohort. For those patients taking
Unilateral or bilateral Unilateral 5 12.2 lopinavir combined with ritonavir, no breast abnormalities
Bilateral 8 19.5 were recorded.
None recorded 28 68.3
ART, Antiretroviral therapy; BMI, body mass index; s.d., standard deviation. Association of breast abnormalities to
†, Defined as test taken ± 3 months from the visit date when breast event is recorded. antiretroviral therapy characteristics and
‡, The description provided by the clinician was used to classify the breast condition. management of adverse events
§, Only single count for each event was taken; in case of multiple description of size from
clinician, the largest size is taken.
All patients with abnormal breast conditions had received
EFV as part of a prior or current regimen. The median time of
Over two-thirds of patients had CD4 counts higher than 500
cells/µL (70.7%, n = 29) and were virologically suppressed as exposure to EFV was 5.5 years. Comparatively, almost 60% of
defined by a viral load of 50 copies/mL or fewer (70.7%, those with abnormal breast conditions had been exposed to
n = 29). The median CD4 count and viral load in this review D4T with a median time of exposure of 4.9 years. This is
were 708.0 cells/µL (IQR: 439.0–957.0 cells/µL) and 176.5 displayed in Table 4.
copies/mL (91.5–373.5 copies/mL) respectively.
From Table 4, we see the prevalence of lipodystrophy in
Clinical and breast characteristics for the sample investigations and interventions for patients
abnormal breast events with abnormal breast conditions. Co-morbid lipodystrophy
was diagnosed in 46.3% of those with abnormal breast
Table 2 shows that there was a lack of information recorded conditions (n = 19).
about the pubertal stage of the adolescents with only four
patients (9.8%) with abnormal breast conditions having The most common intervention was the substitution of EFV
Tanner staging mentioned in their file. 11 for another ARV (n = 16, 39.0%). Of the 19 patients who
received any ART drug substitution, only three cases of
Figure 1 shows a BMI scatter plot for patients at each resolution of the breast condition following ART substitution
abnormal breast event. Approximately 12% (n = 5/41) were were observed, with all three cases occurring in the EFV to
reported as being overweight, which was defined as a BMI nevirapine group.

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