Thanks for your post.
Painful gynecomastia has been
reported among patients receiving HIV treatments, including efavirenz (Sustiva, Estocrin). The true incidence is difficult to estimate from such case series, but in our clinic of less than 1000 patients, we've seen 3 or 4 cases.
How best to manage? Clearly if a switch from efavirenz to another medication is possible, this is likely to be best. Switch from efavirenz to nevirapine (Viramune) would be reasonable, so long as the patient had a lower CD4 count (<250), since the risk of liver toxicity increases above this CD4 level. Alternatively one could consider a switch to a PI (preferably ritonavir-boosted).
In men with painful gynecomastia, we've had success with mastectomy.
Hope this is helpful. BY
