Anova Health Institute, Khutso Kurhula Project, Johannesburg, South Africa.
BMC Pediatr. 2013 Aug 13;13:120. doi: 10.1186/1471-2431-13-120.
Prepubertal gynecomastia is a rare condition and most frequently classified as idiopathic. In HIV-infected adults gynecomastia is a recognised but infrequent side-effect of antiretroviral treatment (ART) and mostly attributed to efavirenz use. Gynecomastia should be distinguished from pseudogynecomastia as part of the lipodystrophy syndrome caused by Nucleoside Reverse Transcriptase Inhibitors (NRTIs) to avoid incorrect substitution of drugs. In the medical literature only five cases of prepubertal gynecomastia in children taking ART are described and underlying pathogenesis was unknown. The occurrence of adverse effects of ART may interfere with therapy adherence and long-term prognosis and for that reason requires attention. We report the first case of prepubertal gynecomastia in a young girl attributed to efavirenz use.
A seven-year-old African girl presented with true gynecomastia four months after initiation on ART (abacavir, lamivudine, efavirenz). History, physical examination and laboratory tests excluded known causes of gynecomastia and efavirenz was considered as the most likely cause. Six weeks after withdrawal of efavirenz the breast enlargement had completely resolved.
Efavirenz-induced gynecomastia may occur in children as well as in adults. With the increasing access to ART, the possibility of efavirenz-exposure and the potential occurrence of its associated side-effects may be high. In resource-poor settings, empirical change from efavirenz to nevirapine may be considered, providing no other known or alarming cause is identified, as efavirenz-induced gynecomastia can resolve quickly after withdrawal of the drug. Timely recognition of gynecomastia as a side-effect of efavirenz is important in order to intervene while the condition may still be reversible, to sustain adherence to ART and to maintain the sociopsychological health of the child.
青春期前男性乳房发育是一种罕见的病症，大多数被归类为特发性。在感染艾滋病毒的成年人中，男性乳房发育是抗逆转录病毒治疗（ART）的一种公认但不常见的副作用，主要归因于依非韦伦的使用。男性乳房发育应与假性男性乳房发育区分开来，后者是核苷逆转录酶抑制剂（NRTIs）引起的脂肪营养不良综合征的一部分，以避免错误替代药物。在医学文献中，仅描述了五例接受 ART 治疗的青春期前男性乳房发育患儿的病例，其潜在发病机制尚不清楚。ART 的不良反应的发生可能会影响治疗依从性和长期预后，因此需要引起重视。我们报告了首例归因于依非韦伦使用的青春期前女童男性乳房发育病例。
一名 7 岁的非洲女童在开始接受 ART（阿巴卡韦、拉米夫定、依非韦伦）治疗四个月后出现真性男性乳房发育。病史、体格检查和实验室检查排除了已知的男性乳房发育原因，认为依非韦伦是最可能的原因。依非韦伦停药后 6 周，乳房增大完全消退。
依非韦伦引起的男性乳房发育也可能发生在儿童和成人中。随着获得 ART 的机会增加，依非韦伦暴露的可能性及其相关副作用的发生可能性可能很高。在资源匮乏的环境中，如果没有发现其他已知或令人担忧的原因，可以考虑从依非韦伦改为奈韦拉平，因为依非韦伦引起的男性乳房发育在停药后很快就会消退。及时认识到依非韦伦引起的男性乳房发育作为一种副作用非常重要，以便在病情仍然可逆时进行干预，维持对 ART 的依从性，并保持儿童的社会心理健康。
