Letter to the Editor - Gynecomastia and HAART
Letter to the Editor - Gynecomastia and HAART
I read with interest the Brief Communication by Drs Mastroianni and Cancellieri in the February issue of The AIDS Reader regarding gynecomastia associated with HAART. In considering the potential causation of gynecomastia as a consequence of HAART, they comment that gynecomastia was not reported frequently before the advent of HAART. This may be in part due to a publication bias where often fatal opportunistic processes were of greater clinical (and academic) interest in the pre-HAART era. In addition, asymptomatic gynecomastia is a common condition in men; therefore, large studies will be needed to determine a true association with HAART. The temporal onset and resolution in the 2 reported cases is, however, consistent with a drug-induced cause. I agree that long-term follow-up of patients receiving HAART will be needed to determine the significance of such effects.
Although the authors state they are the first to report a case of gynecomastia in association with ritonavir therapy, another report has previously described true gynecomastia in association with ritonavir therapy. This case was biopsy-proved and also associated with resolution when nevirapine replaced ritonavir and saquinavir in a 4-drug antiretroviral regimen.
Jeffrey J. Post, MB, BS
Infectious Diseases Registrar
Prince of Wales Hospital
Sydney, Australia
I read with interest the Brief Communication by Drs Mastroianni and Cancellieri in the February issue of The AIDS Reader regarding gynecomastia associated with HAART. In considering the potential causation of gynecomastia as a consequence of HAART, they comment that gynecomastia was not reported frequently before the advent of HAART. This may be in part due to a publication bias where often fatal opportunistic processes were of greater clinical (and academic) interest in the pre-HAART era. In addition, asymptomatic gynecomastia is a common condition in men; therefore, large studies will be needed to determine a true association with HAART. The temporal onset and resolution in the 2 reported cases is, however, consistent with a drug-induced cause. I agree that long-term follow-up of patients receiving HAART will be needed to determine the significance of such effects.
Although the authors state they are the first to report a case of gynecomastia in association with ritonavir therapy, another report has previously described true gynecomastia in association with ritonavir therapy. This case was biopsy-proved and also associated with resolution when nevirapine replaced ritonavir and saquinavir in a 4-drug antiretroviral regimen.
Jeffrey J. Post, MB, BS
Infectious Diseases Registrar
Prince of Wales Hospital
Sydney, Australia
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