Efavirenz’ adverse reactions: a possible link between depression and gynecomastia

Background Reports show that 1.8–8.4% of male patients receiving efavirenz (EFV) develop gynecomastia by unclear multiple mechanisms, one of them being a direct binding to estrogen receptors. However, EFV can independently cause gynecomastia by increasing prolactin levels and we postulate that this mechanism is a dopaminemediated one. Dopamine is a strong prolactin inhibitor. Conversely, a lack of dopamine can cause hyperprolactinemia. On the other hand, dopamine is an antidepressant neurotransmitter and depression is one of the very frequent adverse reactions to EFV. We present the case of an HIV-positive newly diagnosed male patient who developed mild depression and amplified a preexistent gynecomastia after the introduction of an EFV-containing antiretroviral regimen.