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CASE REPORT article

Front. Med.

Sec. Infectious Diseases: Pathogenesis and Therapy

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1574364

Efavirenz-induced grade III gynecomastia in an HIV-positive male patient: a case report and literature review

Provisionally accepted
Lu  ZhouLu Zhou1Yunhao  LuoYunhao Luo2Weiwei  LiaoWeiwei Liao1Delin  YangDelin Yang1*Wen  HuWen Hu3*
  • 1First People's Hospital of Liangshan, Xichang, China
  • 2Chengdu integrated Traditional Chinese Medicine and Western Medicine Hospital, Chengdu, Sichuan Province, China
  • 3West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan Province, China

The final, formatted version of the article will be published soon.

Background: Efavirenz, a non-nucleoside reverse transcriptase inhibitor, is a preferred drug for the treatment of HIV-positive patients. However, one of its adverse effects is gynecomastia, which not only causes psychological distress to patients, affecting their daily lives and work, but also may undermine their treatment adherence. Although numerous studies have documented cases of gynecomastia in HIV-positive patients after antiretroviral therapy (ART), severe cases of gynecomastia are rarely reported.Patient presentation: A 29-year-old male patient initiated a triple therapy regimen of efavirenz, lamivudine, and tenofovir disoproxil fumarate after being diagnosed with HIV. Two years later, he experienced progressive enlargement of the bilateral breasts but did not report the symptoms to his physician. After six years of ART, the patient developed grade III gynecomastia in both breasts, accompanied by significant psychological distress, prompting a visit to the breast surgery department.After excluding other potential drug adverse effects or underlying diseases, the patient's gynecomastia was attributed to efavirenz. Owing to severe enlargement of the breasts, the patient underwent bilateral mastectomy, successfully recovered and was discharged from the hospital.Postoperative follow-up revealed significant improvement in the patient's anxiety and depressive symptoms.Gynecomastia represents a nonnegligible adverse effect of efavirenz that clinicians must recognize and manage promptly. Prior to initiating efavirenz therapy, it is imperative to thoroughly inform patients about potential adverse reactions, emphasizing the importance of seeking medical attention promptly should any side effects arise. Early detection and management of gynecomastia can mitigate its psychological impact and ensure continued adherence to ART.

Keywords: efavirenz, antiretroviral therapy, Gynecomastia, HIV, psychological distress, case report

Received: 12 Feb 2025; Accepted: 04 Sep 2025.

Copyright: © 2025 Zhou, Luo, Liao, Yang and Hu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Delin Yang, First People's Hospital of Liangshan, Xichang, China
Wen Hu, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan Province, China

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