Abstract
BackgroundAntiretrovirals, particularly efavirenz (EFV), have been shown to cause breast abnormalities in adults. Little is known about the prevalence of these adverse effects among adolescents receiving antiretroviral therapy (ART).ObjectivesThe aim of this article was to examine the extent of breast abnormalities in adolescents receiving ART and determine any clinical associations.MethodsA retrospective record review describing breast conditions in adolescents receiving ART at three facilities in Johannesburg was conducted. Patients aged 10–19 years, who presented from January to December 2014, were included in the study. Analyses were conducted to determine whether EFV was associated with increased breast conditions.ResultsOf the 631 patient records reviewed, 37 (6%) had an abnormal breast event documented; with 24/37 (65%) being male patients. Patients with abnormal breast conditions were 1.5 years older than patients with normal breast development (p < 0.0005). Forty-one abnormal breast events were observed in 37 patients, with 20 described as gynaecomastia or lipomastia (49%). 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 suppressed (n = 29). Those on EFV had a significantly higher prevalence of breast abnormalities compared to other regimens (p = 0.016).ConclusionOf 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 needed to better understand the implications of this potential side effect.
Highlights
Antiretrovirals, efavirenz (EFV), have been shown to cause breast abnormalities in adults
Juvenile 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 appropriate time.[2]
Abnormal breast conditions were reported at a median of 13.5 years
Summary
Antiretrovirals, efavirenz (EFV), have been shown to cause breast abnormalities in adults. Little is known about the prevalence of these adverse effects among adolescents receiving antiretroviral therapy (ART). The maturation of the HIV epidemic, including increased access to antiretroviral therapy (ART) 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 abnormalities of their developing, or already developed, breasts.[1]. Breast development in boys may be physiological; this must be 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]
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