Gynaecomastia in the Durban Breast Unit: A Comparison of HIV- and Non-HIV-Infected Individuals

Background: The clinical profile of gynaecomastia patients, both in human immunodeficiency virus (HIV)-positive and HIV-negative patients, in resource-limited settings remains largely undocumented. The aim of this study was to compare and contrast these groups with a view to developing an appropriate treatment algorithm for the South African population. Methods: A retrospective chart review at the Durban Breast Unit for the period 2000–2015 was undertaken with ethics approval [BE012/16 (sub-study of BCA173/15)]. Statistical analysis was done with IBM SPSS version 25. A p value <0.05 indicated statistical significance. Results: One hundred and four patients were documented. The mean age was 37 years. Gynaecomastia was most commonly attributed to puberty, HAART, other medications or an idiopathic aetiology. HIV status was known in 49 patients. There was a 97% prevalence of HAART use in the HIV-positive subgroup (n = 31). Efavirenz was the most common inciting drug. Incidence of gynaecomastia correlated with duration of HAART use. Age, late presentation, advanced Simon grade and bilateral disease appear to necessitate surgical intervention more frequently. Conclusion: Patients on HAART are advised to seek early advice upon noticing gynaecomastia. Drug cessation/change is likely to assist only upon early presentation resulting in static progression, and ultimate cure would still entail surgical excision. Extensive blood and imaging studies should be done only where clinically indicated and can be considered in cases of recurrence post-surgery. Management option must be discussed with patients, and surgeons are required to be familiar with the various surgical techniques necessary to treat gynaecomastia.