Human Immunodeficiency Virus Pre-Exposure Prophylaxis: Use of Emtricitabine/Tenofovir Alafenamide

Pre-exposure prophylaxis (PrEP) involves the use of antiretroviral medication in concert with safer sex practices to significantly reduce the risk of type 1 human immunodeficiency virus infection. In October 2019, daily use of emtricitabine/tenofovir alafenamide (FTC/TAF) 200 mg/25 mg was approved as a newer agent for PrEP to prevent HIV-1 infection in at-risk adults and adolescents. The purpose of this article is to: 1) provide an overview of the FTC/TAF regimen and its safety and efficacy profiles, 2) discuss indications and contraindications of FTC/TAF as PrEP, 3) provide a focused comparison of FTC/TDF with FTC/TAF, and 4) examine issues surrounding cost and accessibility in the United States.     

替诺福韦对HBV BCP突变孕妇HBV母婴的疗效观察

目的观察替诺福韦对HBV基本核心启动子(BCP)突变孕妇HBV母婴的疗效。方法将慢性乙型肝炎孕妇分为治疗组(产前自愿接受治疗)和对照组(产前拒绝接受治疗)。根据是否发生HBV基本核心启动子(BCP)区1 762/1 764双位点突变,将治疗组、对照组孕妇分为突变株治疗组、野毒株治疗组、突变株对照组、野毒株对照组。突变株治疗组、野毒株治疗组分别于孕期第26周、第32周开始口服替诺福韦,分娩后即停药；突变株对照组、野毒株对照组均不用药,比较各组抗病毒疗效及乙肝母婴阻断效果。结果用药后6周、分娩前以及产后6个月突变株治疗组、野毒株治疗组HBV-DNA载量低于突变株对照组、野毒株对照组(P＜0.05)。新生儿出生时、7月龄及12月龄时突变株治疗组、野毒株治疗组HBV-DNA阳性率、HBsAg阳性率均分别低于突变株对照组、野毒株对照组,但组间差异无统计学意义(P＞0.05)。突变株治疗组与突变株对照组、野毒株治疗组与野毒株对照组新生儿身高、体质量、头围、Apgar评分比较,差异均无统计学意义(P＞0.05)。结论应用替诺福韦治疗可提高HBV BCP突变孕妇HBV母婴的疗效。     

Early kidney injury during long-term adefovir dipivoxil therapy for chronic hepatitis B

AIM: To evaluate urine β2-microglobulin(β2-M), retinol-binding protein(RBP) excretion, and renal impairment with adefovir dipivoxil(ADV) for chronic hepatitis B. METHODS: We enrolled 165 patients with chronic hepatitis B infection who were treated with ADV monotherapy(n = 90) or ADV plus lamivudine combination therapy(n = 75). An additional 165 chronic hepatitis B patients treated with entecavir were recruited as controls. We detected serum creatinine, urine β2-M, and RBP levels, and estimated the glomerular filtration rate(e GFR) at the initiation of antiviral therapy and every 6 mo for a period of five years. RESULTS: Urine β2-M abnormalities were observed in patients during the first(n = 3), second(n = 7), third(n = 11), fourth(n = 16), and fifth(n = 21) year of ADV treatment. Urinary RBP abnormalities were observed in patients during the first(n = 2), second(n = 8), third(n = 12), fourth(n = 15), and fifth(n = 22) year of ADV treatment. e GFR decreased 20%-30% from baseline in 20 patients, 30%-50% in 12 patients, and > 50% in 3 patients during the five years of treatment. Further analysis indicated that decreases in e GFR of ≥ 30% relative to the baseline level correlated significantly with urine RBP and β2-M abnormalities. In contrast, both serum creatinine and e GFR remained stable in patients treated with entecavir, and only one of these patients developed a urine β2-M abnormality, and two developed urine RBP abnormalities during the five years of treatment. CONCLUSION: Urine RBP and β2-M are biomarkers of renal injury during long-term ADV treatment for chronic hepatitis B, and indicate when treatment should be switched to entecavir.     

小剂量阿德福韦酯导致低血磷性骨软化症两例并文献总结

目的 分析小剂量阿德福韦酯（ADV）导致低血磷性骨软化症的临床特点、治疗及预后。方法 结合我院诊断的两例服用阿德福韦酯后发生低血磷性骨软化症患者资料和国内外文献,对该症的临床特点、治疗、预后和早期诊断进行总结。结果 服用小剂量阿德福韦酯治疗慢性乙型肝炎导致低血磷性骨软化症患者共12例,男9例,女3例,均来自亚洲人群,年龄在（22~74）岁,服用阿德福韦酯（18~64)个月发现低血磷,血磷波动在（0.37~0.79）mmol/L,血钙正常或偏低,血钾偏低,且均有不同程度的骨质疏松,予补充钙剂、骨化三醇、欧思美等治疗预后良好。结论 小剂量阿德福韦酯所致低血磷性骨软化症临床相对少见,容易漏诊,凡服用阿德福韦酯的患者,无论剂量大小,均应定期检查血肌酐、血钙、血磷及骨密度,以监测是否发生肾损害及低血磷性骨软化症,以期早期诊断,一旦各项指标异常应立即停药,同时可换用其他抗病毒药,如干扰素、恩替卡韦等。     

阿德福韦酯联合胸腺肽α1治疗高病毒载量慢性乙型肝炎110例临床分析

乙型肝炎病毒（HBV）持续感染易引起乙型肝炎慢性化、肝硬化以及肝细胞癌,而持续HBV高载量是慢性乙型肝炎（CHB）患者病情进展的主要原因之一。核苷（酸）类药物治疗CHB的有效性已获得临床广泛认可,但随着以拉米夫定为首的核苷（酸）类药物的广泛使用,耐药基因突变及临床耐药问题异常突出。国内外越来越多的专家认为,联合治疗将是CHB抗病毒治疗的方向。由于拉米夫定治疗CHB耐药基因突变率高,