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

Gynecomastia is defined as benign proliferation of the glandular tissue ofthe male breast. It is usually palpated as a glandular mass of tissue (greater than0.5 cm) which is symmetrical and located centrally just beneath nipple-areolar complex. Gynecomastia has been recognized as an uncommon adverse effect of few anti-retroviral (ARV) drugs. Among the currently used ARV drugs, efavirenz has been documented in literature to cause the same. Although the exact pathogenesis is unknown, two possible mechanism implicated are immune restoration following treatment and direct stimulation of estrogen receptors present in the breasts. Lipomastia (pseudo-gynecomastia) is a benign breast enlargement, which occurs as a part of fat re-distribution syndrome associated with highly active antiretroviral therapy (HAART), it must be differentiated from true gynecomastia. We here in describe a case of 24 year old retro-positive individual who develop gynecomastia following efavirenz based anti-retroviral therapy. We also did a review of literature, enumerating the frequency of the ARV drug induced gynecomastia, various investigation needed and available treatment option for the same.