This issue’s specialist:
Sharon Valenti, M.D., N.P., AAHIVS
Dear HIV Specialist,
My partner started on Atripla at the same time I did (one year ago) and both of us are now suffering from right breast engorgement with pain. Is this a common side effect?
Signed, In Pain
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Dear IP,
The condition of breast enlargement or engorgement in men is called gynecomastia (guy-na-ko-mass-tee-a). It is a benign (not cancerous) condition and represents an increased amount of ductal tissue in the breast, along with an increase of connective tissue supporting the ducts. This can happen in one breast or both. Gynecomastia is confirmed by a mammogram and biopsy. There is another benign condition, called lipomastia, which is an accumulation of fat in the breast. This condition may be controlled or eliminated with diet and exercise. Both conditions, however, must be evaluated by mammography. Rarely, certain cancers, such as lymphoma, may be the cause of breast enlargement.
Highly Active Antiretroviral Therapy (HAART) has been implicated in the development of gynecomastia and lipomastia in HIV-positive men. Interestingly, it was not until the initiation of HARRT, in the mid- to late 90s, that more and more cases of gynecomastia were reported. The use of drugs in the protease inhibitor class of antiretrovirals have most often been implicated, but other clinical trials have found the use of nucleoside analogs and non-nucleoside analogs may also contribute to the condition of lipomastia. Atripla is made up of a non-nucleoside (efavirenz) and two nucleosides (emthcitabine and tenofovir).
In the case of true gynecomastia, it is important to understand that there are other drugs and physical conditions that may be the cause. Drugs, such as those used to treat cardiovascular conditions or gastric ulcer diseases, have been implicated, as well as long-term use of marijuana. Other chronic conditions, such as hepatitis and kidney disease, may also produce the symptoms of breast enlargement. It is important that your physician evaluate your condition to determine the precise cause of your breast enlargement in order to provide the best treatment for you.
