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Recently, while speaking to a patient from Nigeria I was very concerned to discover that she had been taking combivir for breast enhancement. On closer questioning it appears that she had accessed this drug, passed to her in individual sachets with no information insert etc, via a friend. Her friend, knowing that my patient wished for larger breasts, had passed her the combivir to use on an as required basis for breast enhancement. My patient claims that the drug did work to enlarge her breasts.
The drugs were apparently prescribed by a doctor in Nigeria at the cost of about US$250 for six sachets and the pharmacist dispensing them had been asking why the girls were taking them. Apparently the sachets did not come with any leaflets or drug information inserts.
My patient and her friends appeared to be totally unaware of the fact that the combivir was for use in HIV therapy and were unaware of any potential side effects from the drug. It was only when my patient was surfing the web that she found out about the licensed use for combivir.
My patient, sadly, acquired HIV from a blood transfusion in Africa and on primary resistance testing showed very broad nucleoside reverse transcriptase inhibitor resistance and apparent full sensitivity to protease inhibitors and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Resistance to NNRTIs was only confirmed after weeks of unsuccessful therapy by further resistance testing.
My patient has alerted all her friends in Nigeria as to the real nature of combivir and advised them to stop using it for breast enhancement. She has also told me that she believes the doctor in Nigeria who prescribed these drugs may have had this activity terminated.
Because no one I have spoken to has come across this particular misuse of antiretroviral therapy I felt it was worth highlighting to a wider audience in the hope that such practises may be addressed.
This patient has agreed to publish details of her case to help prevent recurrent misuse of this drug.
Sherwood Forest Hospitals NHS Trust Research and Development committee approval
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