I am a 31 years old male. I have seroconverted in September 1995 and have been on HAART (Sustiva + DDI + D4T) since December 1998. Soon after I began HAART my VL went below 50 copies (from 35.000) and my CD4 up to 650 (from 450). Six weeks ago I noted that my right breast began to hurt and enlarge slightly. I had this checked by echography and X-ray and I was diagnosed gynecomastia, also in the left side although to a smaller extent. Further to that, my doc checked my female hormones and their levels were not abnormally high. I have learned that male breast enlargement can be a result of HAART, D4T in particular in my current regime. Do you think this is the case? Is there any way to reverse this situation besides removing the mammary gland with surgery? Thanks for your help.

Good question (you don't mention what your levels of the male hormones were, ie testosterone). Most of the breast enlargement I have seen has been with protease inhibitors. The fat problems most closely linked to D4T have been fat wasting.That being said I have encountered several patients such as yourself which challenge my understanding. If no other medical conditions exists than I can think of several options.

You could try to change your HIV regimen to something like Combivir/Ziagen or Combivir/Viramune which should still suppress your virus and then observe what happens.

You could also consider a drug holiday since your initial blood test results weren't that bad. KH