TAF作为范可尼综合征和多药耐药史乙肝肝硬化患者的抢救治

antiHBVren

Tenofovir alafenamide as a rescue therapy in a patient with HBV-cirrhosis with a history of Fanconi syndrome and multidrug resistance[url=]Glenda Grossi[/url]
, [url=]Alessandro Loglio[/url]
, [url=]Floriana Facchetti[/url]
, [url=]Marta Borghi[/url]
, [url=]Roberta Soffredini[/url]
, [url=]Enrico Galmozzi[/url]
, [url=]Giovanna Lunghi[/url]
, [url=]Anuj Gaggar[/url]
, [url=]Pietro Lampertico[/url][url=]Correspondence information about the author Pietro Lampertico[/url]Email the author Pietro Lampertico


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DOI: http://dx.doi.org/10.1016/j.jhep.2017.08.020

Article Info
Abstract

Tenofovir disoproxil fumarate (TDF) is a recommended first-line therapy for both naïve and experienced patients with chronic hepatitis B (CHB), although reduced estimated glomerular filtration rate (eGFR), hypophosphatemia, hyperphosphaturia and Fanconi syndrome have been reported in some patients. Entecavir (ETV) could be considered as a rescue therapy for TDF-treated patients developing renal dysfunction, though patients with prior history of treatment with lamivudine (LAM) can develop ETV resistance strains, which can lead to potentially severe hepatitis flares. Tenofovir alafenamide (TAF), a new prodrug of tenofovir, has recently been developed to improve the renal and bone safety profile compared to TDF, while maintaining the same virologic efficacy. The recently published 48-week phase III TAF registration studies confirmed the superior safety profile. Here we describe a case of a 75-year-old woman with HBV mono-infection and compensated cirrhosis who developed ETV resistant strains and grade 3 chronic kidney disease after many years of LAM and adefovir (ADV) treatment and a TDF-induced Fanconi syndrome. The administration of 25 mg/day of TAF, granted as part of a compassionate use program, rapidly suppressed viral replication to undetectable levels without worsening renal function or side effects.

Keywords:TAF, Renal safety, Hepatitis B virus, Tenofovir, Drug resistance, Oral therapy

antiHBVren

替诺福韦艾拉酚胺作为一种具有范可尼综合征和多药耐药史的HBV-肝硬化患者的挽救疗法

抽象
慢性乙型肝炎（CHB）患者的替诺福韦二吡呋酯富马酸（TDF）是一种推荐的一线治疗方法，尽管一些患者已经报道了估计的肾小球滤过率（eGFR），低磷酸盐血症，高磷酸尿症和Fanconi综合征。恩替卡韦（ETV）可被认为是TDF治疗的肾功能不全患者的挽救性治疗，虽然之前有拉米夫定（LAM）治疗史的患者可以发展ETV耐药菌株，这可能导致潜在的严重肝炎。替诺福韦艾拉酚胺（TAF）是替诺福韦的一种新型前药，最近开发出来用于改善肾脏和骨骼安全性，与TDF相比，同时保持相同的病毒学疗效。最近公布的为期48周的第三阶段TAF注册研究证实了其优越的安全性。在这里，我们描述了一个75岁的女性HBV单一感染和代偿性肝硬化的病例，经过多年的LAM和阿德福韦（ADV）治疗和TDF诱导的Fanconi综合征后，发展为ETV耐药株和3级慢性肾病。作为同情使用项目的一部分，给予25毫克/天的TAF，迅速将病毒复制抑制到不可检测的水平，而不会恶化肾功能或副作用。

关键词：
TAF，肾脏安全性，乙型肝炎病毒，替诺福韦，耐药性，口服疗法