Updates
Bodegas Bust Bugs?
Source: Markel H. New York Times. November 12, 2002; F6.
With an increasing number of Silicon Valley immigrants and foreign residents seeking consultation (although some of this has diminished with the downturn in the economy the past year), I am often confronted by patients who are taking foreign antibiotics, some of which are not readily recognizable or similar to a US-approved drug. Many of these persons are from India, the Philippines, China, and Mexico. Antibiotics and pain relievers are especially common, and they can be obtained during trips back home or mailed to the United States by relatives overseas. Most patients think nothing about taking medications from home.
Similarly, the growing "antibiotic underground" from Mexico to the United States is beginning to concern public health officials. This recent article in the New York Times highlights the growing "bodega" business on the East Coast, where medications can be readily purchased without prescription in small markets or swap meets. Amoxicillin and other antibiotics are some of the biggest sellers. The practice is especially common in Chinese, Latino, and Russian communities in New York and the District of Columbia. The practice of self-medication has been so common that many local physicians now ask what antibiotic a child or adult may have already taken by the time they see a doctor. Medical care has become so expensive, especially for the uninsured, that patients may not be able to afford the doctor visit and the medications, and instead turn to cheaper non-US versions of antibiotics.
Public health officials are concerned about the over-use of antibiotics in these communities and the potential impact on resistance. Local police and health departments generally don’t pay much attention to these small bodega markets, which can quickly relocate, and US Customs states that seizing illegal antibiotics at the borders is not a priority. Can you really see the police arresting someone for selling amoxicillin?
TNF in HIV/HBV Coinfected Adults
Source: Ristig MB, et al. J Infect Dis. 2002;186:1844-1847.
HIV clinicians have long been lobbying for more data on the effectiveness of tenofovir (TNF, Viread®) in HIV-infected patients with chronic hepatitis B. TNF is a nucleotide analog with proven clinical efficacy against HIV, excellent activity in vitro against HBV, and a favorable safety profile, making it a natural choice for coinfected patients.
Ristig and colleagues assessed the effectiveness of TNF in 6 HIV/HBV-infected adults, all of whom were failing treatment with lamivudine (3TC) and interferon-a. At the beginning of the study, all of the patients had clinical evidence of virologic resistance, with a mean HBV viral load of 7.95 log10 copies/mL (6.97-8.72 log10 copies/mL) despite treatment with 3TC and interferon. All 6 were HBV-surface-antigen- and e-antigen-positive, and 4 of 5 who had undergone liver biopsy had evidence of cirrhosis. TNF 300 mg was administered once daily for 24 weeks, in addition to existing highly active antiretroviral therapy.
In 12-24 weeks of treatment with TNF, HBV viral loads were significantly reduced to 4.8 ± 1.0 log10 copies/mL and 3.6 ± 0.4 log10 copies/mL, respectively. Two of 6 patients had undetectable HBV viral loads at week 24—one of whom had a CD4 count of 0 cells/mm3. No patient developed new anti-Hbe. These extremely promising data deserve further investigation.
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