Efavirenz Induced Gynecomastia: An Uncommon Forgotten Adverse Effect and Review of Literature

Swain S, Soneja M, Nischal N and Wig N

Published on: 2022-03-10

Abstract

Gynecomastia is defined as the benign proliferation of the male breast which is usually palpable as a smooth compressible glandular tissue mass beneath the nipple areola complex. Gynecomastia has been recognised as an uncommon adverse effect of few anti-retroviral drugs. Efavirenz is one of the currently used drug which has been documented to cause the same. Although the exact pathogenesis is unknown, two possible mechanisms are implicated, it may be due to immune restoration following treatment and/or direct stimulation of the estrogen receptors present in the breast. Lipomastia (pseudo gynecomastia) is a benign breast enlargement which occurs as a part of the fat redistribution sunder associated with several ARV drugs. But unlike gynecomastia, here there is no glandular development of the breast tissue and it is just the deposition of skin and/or adipose tissue. We herein describe a case of a 24 years old retro positive individual who develops gynecomastia following efavirenz based ARV therapy. We also did a review of the literature, enumerating the frequency of ARV drug induced gynecomastia, various investigations needed and the treatment options available.