Gynecomastia caused by efavirenz: Two cases with different severity

Gynecomastia is the proliferation of mammary glands in men due to physiological changes, systemic diseases, tumours, and certain medications. Drug-induced gynecomastia is rare. Efavirenz is the most frequently reported ARV in several studies and case reports as a cause of gynecomastia. Case: Two HIV-infected men complained of enlarged breasts with pain without nipple discharge. Complaints arose after the initiation of efavirenz-based ARVs. Breast examination revealed bilateral swelling in the form of a mass of soft consistency, supple, concentric on the nipple-areola, well-defined, movable, and painful to palpation. Ultrasound examination supports the appearance of gynecomastia. Examination of liver function, kidney, thyroid hormone, testosterone, β-hCG, and estradiol was within normal limits. Discussion: HIV-associated gynecomastia involves pathophysiological changes such as hypogonadism, increased prolactin production, and the presence of HIV-associated cirrhosis, as well as the effects of antiretroviral drugs. Gynecomastia diagnosis is based on clinical, hormonal, and ultrasound examinations. Assessment of causal drug causes using the Naranjo algorithm. Regression of drug-associated gynecomastia occurs 1-5 months after the drug is discontinued. Conclusion: Two cases of EFV-associated gynecomastia have been reported. Efavirenz substitution should be investigated to avoid a drop in medication adherence due to gynecomastia-related distress. © 2023 Pakistan Association of Dermatologists. All rights reserved.