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Abstract
Gynecomastia during congenital HIV infection treated with antiretrovirals
Manfredi R.1, Calza L.1, Chiodo F.1
Introduction: Gynecomastia (G) is an emerging adverse event of antiretroviral-treated HIV disease. Although initially related to HIV protease inhibitors (PI) and dysmetabolism, it has been recently reported in patients (p) who never received or abandonded PI.
Methods: A perinatally HIV-infected p at the age of 13.5 years developed a true, ultrasonography-confirmed bilateral, asymmetrical G, responsible for mild local disconfort.
Results: Height-weight development and pubertal stage were within normal limits. At the age of 5 years our p started anti-HIV therapy, never stopped thereafter. During the 10-year subsequent follow-up, 6 different therapeutic lines were used, including PI-based HAART. When considering nucleoside analogues (NA), stavudine (d4T) was the compound used for a longer time (61 months). When G was diagnosed, a negligible viremia was retrieved (280 HIV-RNA copies/mL), while CD4+ lymphocyte count was 848 cells/µL. Our p never presented lipodystrophy-defining alterations, and no metabolic abnormalities were detected. An endocrinological workout did not disclose any gonadal, hypophyseal, thyroid, and prolactin abnormality. Chronic liver and/or kidney failure, and administration of drugs potentially related to G, were carefully excluded. G did not show modifications during the subsequent 22 months of observation.
Conclusions: Among over 200 reports of HIV-associated G described to date, none emerged in pediatric-adolescental age. Both pathogenesis-evolution of G are increasingly investigated, with attention focused on dysmetabolic alterations and lipodystrophy (absent in the presented p), as well as single agents and their combinations. Among NA, d4T seems the most frequently implicated molecule, although biases due to its large-scale use cannot be excluded.In the described p ,NA and PI were given during 9.5 and 8 years. In our p, who represents the first described case of true G in a child, the absence of lipodystrophy and/or dysmetabolism, makes uncertain the existence of common pathogenetic pathways.
The 3rd IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
MoPe9.4C01
Suggested Citation
"ManfrediR., et al.
Gynecomastia during congenital HIV infection treated with antiretrovirals.
Poster Exhibition:
The 3rd IAS Conference on HIV Pathogenesis and Treatment:
Abstract no.
MoPe9.4C01"
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