CT-detected gynecomastia in men living with HIV: prevalence, radiological patterns, and associated factors

To determine the prevalence of CT-detected gynecomastia in men living with HIV, characterize its radiological subtypes, and investigate potential associations with hormonal, clinical, virological, and treatment-related factors. This retrospective observational study included 170 adult men living with HIV who underwent thoracic computed tomography (CT) examinations performed on a Somatom Definition Flash multidetector CT scanner (Siemens Healthineers, Forchheim, Germany) between January 2023 and January 2025. CT examinations were reviewed for the presence of gynecomastia, laterality, and radiological subtype (nodular, dendritic, or diffuse). Demographic characteristics, duration of HIV infection, antiretroviral treatment (ART) regimens, hormonal parameters, body mass index (BMI), CD4 and CD8 counts, CD4/CD8 ratio, HIV RNA levels, and CDC stage were obtained from medical records. Multivariable logistic regression analyses were performed to identify factors associated with gynecomastia and its radiological subtypes. The mean age of the study population was 39.7 ± 11.8 years. Gynecomastia was identified in 60 patients (35.3%), with bilateral involvement in 86.7% of cases. Bilateral disease was present in 68.2% of nodular, 84.2% of dendritic, and 95.2% of diffuse gynecomastia cases. The prevalence of gynecomastia did not differ significantly among ART regimens (p = 0.743). Estradiol levels, testosterone levels, estradiol-to-testosterone ratio, BMI, CD4 count, CD8 count, CD4/CD8 ratio, and HIV RNA levels were not independently associated with gynecomastia. In multivariable analyses, use of DTG/3TC was associated with lower odds of gynecomastia (OR: 0.115, p = 0.033). For diffuse gynecomastia, longer duration of HIV infection was independently associated with increased odds (OR: 1.419, p = 0.005). No independent predictors were identified for nodular or dendritic gynecomastia. Gynecomastia is a common incidental finding on thoracic CT in men living with HIV, affecting more than one-third of patients in this cohort. Despite the relatively young age of the study population, the prevalence was comparable to that reported in large CT-based studies from the general Turkish population. HIV duration, rather than hormonal, immunological, or virological parameters, was associated with diffuse gynecomastia, suggesting that breast tissue changes may reflect cumulative long-term effects of HIV infection and its treatment. Not applicable.