The incidence and description of gynaecomastia in HIV positive adolescents on antiretroviral therapy

Abstract

Background:This study aimed to determine the incidence and clinical characteristics associated with gynaecomastia inHIV-infected adolescents attending Harriet Shezi Children’s clinic (HSCC) in Johannesburg, South Africa. Methods:This retrospective reviewwas conducted on 622 HIV-infected male adolescents between January 2004 and December 2014. Demographic andclinical characteristicswere assessed atantiretroviral therapy(ART) initiation,and start of person-time at risk (T0) for developing gynaecomastia (either at age 10 years or first visit after 10 years). Gynaecomastia was diagnosed clinically by the attending clinician at clinic visits.Descriptive analysis and measures of association were conducted. Results:While on ART44(7.1%)adolescents developed gynaecomastia at a median age of 14.6 years (IQR: 13.9-15.7).Overall incidence was 2.4/100person-years (95% CI: 1.8 3.3).Adolescents who initiated ART after 10 years of age were more likely to develop gynaecomastia than those initiated before 10 years (OR: 1.20, IQR 1.18-1.40).Adolescents who were wasted at ART initiation (18%) and adolescents on ART prior to T0weresignificantly less likely to develop gynaecomastiacompared to those who were not (OR=0.22, IQR: 0.17-0.28 and OR=0.43, IQR: 0.23-0.79, respectively).In longitudinal regression analysis, adolescents on an EFV-basedregimen at T0 were more likely to develop gynaecomastia than those who were not (OR=3.42, IQR: 1.12-10.42). Conclusion:This study adds to the previously reported association between efavirenz and gynaecomastia in HIV-infected males. However, better designed studies are needed to clarify the relationship between gynaecomastia, HIV-infection and ART drugs, especially in adolescence where this relationship is confounded by physiological gynaecomastia