HIV and the breast

HIV infection and antiretroviral therapy may alter the spectrum and frequency of diseases that affect the breast. The differential diagnosis of conditions of the breast that a practitioner may encounter in HIV-infected persons includes infection, morphologic alterations, and malignancy. Atypical infections may involve the breast as CD4+ T-cell counts wane. More commonly, HIV-infected persons present with gynecomastia, which may be caused by a variety of conditions, including exposure to HAART. True gynecomastia, resulting from proliferation of male breast ducts and periductal stroma, might be differentiated from lipomastia--a manifestation of lipodystrophy, characterized by the deposition of adipose tissue in the breast. In the era of HAART, HIV-infected patients with malignancy--particularly those who have robust CD4+ T-cell counts and well-controlled HIV viral loads--should be treated similarly to their HIV-negative counterparts.