慢性乙型肝炎患者完全病毒抑制后替诺福韦酯对延胡索酸耐

StephenW

World J Gastroenterol. 2018 May 7;24(17):1919-1924. doi: 10.3748/wjg.v24.i17.1919.
Development of tenofovir disoproxil fumarate resistance after complete viral suppression in a patient with treatment-naïve chronic hepatitis B: A case report and review of the literature.
Cho WH1, Lee HJ1, Bang KB1, Kim SB2, Song IH1.
Author information

1
    Department of Internal Medicine, Dankook University College of Medicine, Cheonan 31116, South Korea.
2
    Department of Internal Medicine, Dankook University College of Medicine, Cheonan 31116, South Korea. [email protected].

Abstract

Tenofovir disoproxil fumarate (TDF) is a potent nucleotide analogue that is recommended as first-line therapy for patients with chronic hepatitis B. The results of a longitudinal study of TDF treatment demonstrated no development of resistance. We observed one treatment-naïve chronic hepatitis B (CHB) patient who developed TDF resistance after complete viral suppression during long-term TDF treatment. A 37-year-old HBeAg-positive man received TDF 300 mg/d for 43 mo. The hepatitis B virus (HBV) DNA titer was 8 log10 copies/mL at baseline and became undetectable at 16 mo after treatment. However, the HBV DNA titer rebounded to 7.5 log10 copies/mL at 43 mo after treatment. We performed full sequencing to find mutation sites associated with virologic breakthrough. The results showed 9 mutation sites, most of which had not been well-known as mutation sites. We changed the therapy from tenofovir to entecavir with a regimen of 0.5 mg once daily. After 4 mo, the HBV DNA titer decreased to 267 copies/mL, and the liver enzyme levels were normalized.
KEYWORDS:

Chronic hepatitis B; Mutation; Resistance; Tenofovir

PMID:
    29740207
PMCID:
    PMC5937209
DOI:
    10.3748/wjg.v24.i17.1919

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StephenW

世界J Gastroenterol。 2018年5月7日; 24（17）：1919-1924。 doi：10.3748 / wjg.v24.i17.1919。
慢性乙型肝炎患者完全病毒抑制后替诺福韦酯对延胡索酸耐药的研究：一例病例报告和文献综述。
Cho WH1，Lee HJ1，Bang KB1，Kim SB2，Song IH1。
作者信息

1
    丹东大学医学院内科，韩国天安31116。
2
    丹东大学医学院内科，韩国天安31116。 [email protected]。

抽象

替诺福韦地索普西富马酸盐（TDF）是一种有效的核苷酸类似物，推荐作为慢性乙型肝炎患者的一线治疗。TDF治疗的纵向研究结果显示没有发展抗药性。我们观察到一位未经治疗的慢性乙型肝炎（CHB）患者在长期TDF治疗期间完全病毒抑制后出现TDF耐药。一名37岁的HBeAg阳性男性接受TDF 300 mg / d治疗43个月。乙型肝炎病毒（HBV）DNA滴度在基线时为8log10拷贝/ mL，在治疗后16个月时检测不到。然而，在治疗后43个月，HBV DNA效价反弹至7.5log10拷贝/ mL。我们进行了全面测序，寻找与病毒学突破相关的突变位点。结果显示9个突变位点，其中大多数不是众所周知的突变位点。我们将替诺福韦疗法改为恩替卡韦，每日一次，剂量为0.5毫克。 4个月后，HBV DNA滴度降至267拷贝/ mL，肝酶水平正常化。
关键词：

慢性乙型肝炎;突变;抵抗性;替诺福韦

结论：
    29740207
PMCID：
    PMC5937209
DOI：
    10.3748 / wjg.v24.i17.1919

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StephenW

https://www.wjgnet.com/1007-9327/full/v24/i17/1919.htm

REMEMBERFORGET

抗病毒能力，恩替还是差一些。
但替诺耐药后，只能凑合着用恩替了！
现有乙肝药物，效果差强人意