Page 330 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 6 of 7 Original Research

Interventions for breast abnormalities and, therefore, may have similar algorithms for managing
their patients. This may have affected the detection of
While over half of patients received an intervention cases, descriptions used, paucity of investigation as well as
(n = 21/41), only three cases were reported to resolve. Of these interventions used, particularly those of drug substitution.
patients, all three received an EFV to nevirapine substitution,
whereas no resolution was seen in patients with any other Conclusion
drug substitution, drug prescription or prescribed lifestyle
changes. There was no association established between the Children on ART may develop breast abnormalities during
resolution of abnormal breast events with substitution to adolescence. It is proposed that the drug choice for
nevirapine; however this was most likely because of the adolescent ART, particularly those regimens containing
small numbers of breast abnormalities and the limited study EFV, when interacting with the fluctuating hormonal levels
period. during puberty, may account for this unique presentation of
breast abnormality. This study demonstrated that the use of
While tamoxifen, an antioestrogen drug used for treating EFV and increasing age were associated with breast
gynaecomastia, 3,16 was prescribed for one patient, it was abnormalities in this population. The role of EFV in the
never received. For this reason, tamoxifen remains an development of breast abnormalities in both male and
unexplored intervention in this cohort. female adolescents requires further exploration to determine
the appropriate investigations to perform and the most
Most patients’ breast abnormalities were not reported to effective interventions to employ.
resolve and very few were referred on to the next level of
care. Of the three that were referred, none received a definitive Acknowledgements
intervention. This could be attributed to a lack of knowledge
on how to manage these cases at a specialist level and thus Competing interests
our findings support that further research is needed to The authors have declared that no competing interests exist.
develop management algorithms.

Authors’ contributions
Comorbidities and concomitant medication
All authors contributed actively and meaningfully to this
One or more comorbidity was observed in almost three-
quarters of patients with abnormal breast conditions. article.
Lipodystrophy was noted in just under half of the patients.
Only 12% of this cohort were overweight; however, a Funding
relationship between gynaecomastia and obesity was not This work was financially supported by United States Agency
established. 3 for International Development (USAID) under Grant No.
674-A-12-00029.
Limitations

• Although a sample size of 631 patients from 1376 files Data availability statement
should be sufficient to answer the research question, a The data set will be made available from the corresponding
small number of cases were identified, resulting in small author upon request.
subgroups (e.g. boys and adolescents using particular
ARVs). It is therefore a possible limitation that the sample
size was too small for subgroup comparisons. Disclaimer
• There are no comparative studies establishing the The views and opinions expressed in this article are those of
frequency of breast abnormalities in this population with the authors and do not necessarily reflect the official policy or
a control group (i.e. adolescents who are not HIV-infected position of any affiliated agency of the authors.
or HIV-infected adolescents not on ART).
• The prevalence of breast abnormalities in patients less References
than 10 years old could not be commented on.
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