Doctors have been warned not to assume that male breast enlargement in HIV-positive patients is just another side effect of HIV treatment in a report to the journal Clinical Infectious Diseases.
Male breast enlargement, usually diagnosed as gynaecomastia, has been reported since 1998 in men receiving highly active antiretroviral therapy (HAART). Although case reports are rare, its prevalence has not been established, and its causes are unclear. Whilst some researchers believe it is a side-effect of HAART, others believe it has more complex causes.
Researchers from Boston and Seattle reported on the characteristics of 13 cases seen during an 18 month period at two clinics. Although nine men had developed gynaecomastia, mainly characterised by enlargement and tenderness on one side of the chest, three patients had developed lymphoma (one bilateral, two unilateral).
The researchers warned that cases of breast enlargement should not be dismissed as drug side-effects, and also pointed out that gynaecomastia can also be caused by other medications. Two of the individuals who developed gynaecomastia were not receiving HIV treatment at the time of diagnosis, three were receiving treatment with drugs known to cause gynaecomastia and three were long-term users of marijuana. One case combined all three of these features. Only one out of 13 patients had low testosterone levels (hypogonadism).
Evans DL et al. Breast enlargement in 13 men who were seropositive for human immunodeficiency virus. Clinical Infectious Diseases 35: online edition, 2002.