Boob-man burns bra

Dr. Sindi van Zyl

1 April 2010

Some of you might remember the Sowetan headline “Man grows boobs”. Who can forget the bizarre photo of a scrawny man who developed perky breasts as a rare side-effect of his ARV treatment? (read more about this case here)

In the past, some people may have considered the South African government’s response to HIV/AIDS to be laughable, but today this seems to have changed. This is no April fool’s joke: the new South African Antiretroviral Therapy (ART) guidelines have just been officially launched. The guidelines are in line with the latest WHO recommendations, and perhaps the greatest change has been the inclusion of Tenofovir Disiproxil Fumarate – (TDF) as part of first-line therapy. Finally, Stavudine (d4T), the drug responsible for enlarged breasts in men, will be phased out of the programme.

For some patients, d4T caused lipodystrophy. Fat either accumulated or was lost from certain parts of the body. Some patients lost their facial fat and ended up looking gaunt, many lost fat from their limbs and they now have very skinny legs. An even greater number developed fat tummies that they are working hard to get rid off. Those patients can now switch to TDF, and even though their cosmetic state won’t change dramatically, at least the situation will not worsen.

The other major changes include starting ART at CD4 ≤ 350 for all pregnant patients. All patients with TB and those with stage 4 disease will start ART regardless of CD4 count. All children less than a year old that test HIV-positive will also start ART regardless of their CD4 count.

What a great victory for patients!