湖北省以替诺福韦为初治抗逆转录病毒方案的HIV/AIDS患者肾功能情况及其影响因素分析

目的 评估替诺福韦（tenofovir,TDF）作为一线治疗方案的HIV/AIDS患者慢性肾病（chronic kidney disease,CKD）发生情况及其影响因素。方法 采用回顾性队列研究方法,收集分析TDF组和齐多夫定（zidovudine,AZT）组HIV/AIDS的人口学信息及临床检查资料,比较2组患者CKD的发生率和差异,多因素Cox比例风险模型分析TDF组患者CKD发生的影响因素。结果 共纳入432例HIV/AIDS患者,其中TDF组249例,AZT组193例,开始治疗时年龄中位数分别为32（26,50）、31（26,43）岁,传播途径主要以同性传播为主（分别为69.48%、82.90%）。TDF组与AZT组24个月CKD累积发生率分别是2.8%和0,差异有统计学意义（P<0.05）。各时间点肾小球滤过率（eGFR）值中,AZT组均高于TDF组（均P<0.01）。多因素Cox比例风险模型分析显示：TDF组患者中,女性（HR=57.46,95% CI：2.981~67.684）和基线eGFR异常（HR=4.75,95% CI：1.351~16.702）者发生CKD的风险更高。结论 TDF可以引起HIV/AIDS患者CKD的发生,但发生率较低,女性和基线eGFR异常者发生CKD的风险更高。在临床治疗过程中,要密切关注女性患者以及评估患者肾功能。     

Tenofovir gel for HIV prevention for women: Perspectives of Key Opinion Leaders from India

ObjectivesCountry decision-making regarding adoption of new health technologies is a lengthy process that is informed by scientific, public health, and policy analyses. Key Opinion Leaders (KOLs), who include a range of influential individuals (e.g., Ministry of Health officials, leaders of medical and pharmacy associations, civil society representatives, donors), play a critical role in country decision-making around adoption and availability of new HIV-prevention tools. Their perspectives can shape public opinion and influence policy, programming, and procurement decisions.MethodsIn-depth face-to-face interviews with a dozen purposefully selected national KOLs in India were conducted to gain their perspectives around ARV-based prevention for women, focusing on microbicides in general and tenofovir vaginal gel specifically. Theme-based content emerged and was analyzed using ATLAS.ti software.ResultsWhile generally supportive, KOLs expressed caveats regarding the role tenofovir gel might play in the overall HIV-prevention program. Key outstanding issues that would need to be addressed include product effectiveness, potential for resistance, product cost, feasibility of HIV testing and re-testing, and effective targeting of key populations for public health impact.ConclusionsAs new HIV-prevention technologies advance through clinical trials, there is a concomitant necessity to engage in policy analysis exercises. Formative research with stakeholders early in the process is an important yet often overlooked step. The potential role that the tenofovir gel could play in India will depend in large part on epidemiological, public health, and economic factors. Understanding target populations' perspectives on the product will also be critical for its successful introduction.     

替诺福韦酯在乙型病毒性肝炎合并肝硬化患者挽救治疗中的应用

目的探讨替诺福韦酯在乙型病毒性肝炎合并肝硬化患者挽救治疗中的应用效果。方法收集2014-2017年沈阳市第六人民医院收治的乙肝合并肝硬化拉夫米定抗病毒治疗失败的患者89例,以替诺福韦酯进行挽救治疗%周。分别依据挽救治疗前患者HBV定量和谷丙转氨酶(ALT)水平将患者进行分组,比较不同分组情况下HBV累积应答率、乙型肝炎E抗原(HBeAg)累积转换率和ALT累积复常率。结果本组89例患者中,HBV累积应答64例,占71.91%;HBeAg累积转换32例,占35.96%;ALT累积复常74例,占83.15%。低定量组与高定量组HBV累积应答率、HBeAg累积转换率、ALT累积复常率差异均有统计学意义(P值均<0.05)。低转氨酶组与高转氨酶组HBV累积应答率、HBeAg累积转换率、ALT累积复常率差异均无统计学意义(P值均>0.05)。结论替诺福韦酯作为挽救治疗用药,可有效抑制乙型肝炎病毒复制,改善转氨酶和肝炎抗体指标,尤其是对病毒定量水平较低的患者,效果更为明显。     

Asociación Mexicana de Hepatología A.C. Guía Clínica de Hepatitis B

Hepatitis B virus (HBV) infection continues to be a worldwide public health problem. In Mexico, at least three million adults are estimated to have acquired hepatitis B (total hepatitis B core antibody [anti-HBc]-positive), and of those, 300,000 active carriers (hepatitis B surface antigen [HBsAg]-positive) could require treatment. Because HBV is preventable through vaccination, its universal application should be emphasized. HBV infection is a major risk factor for developing hepatocellular carcinoma. Semi-annual liver ultrasound and serum alpha-fetoprotein testing favor early detection of that cancer and should be carried out in all patients with chronic HBV infection, regardless of the presence of advanced fibrosis or cirrhosis. Currently, nucleoside/nucleotide analogues that have a high barrier to resistance are the first-line therapies.     

Tenofovir disoproxil fumarate monotherapy for nucleos(t)ide analogue-na?ve and nucleos(t)ide analogue-experienced chronic hepatitis B patients

Background/Aims

This study investigated the antiviral effects of tenofovir disoproxil fumarate (TDF) monotherapy in nucleos(t)ide analogue (NA)-naive and NA-experienced chronic hepatitis B (CHB) patients.

Methods

CHB patients treated with TDF monotherapy (300 mg/day) for ≥12 weeks between December 2012 and July 2014 at a single center were retrospectively enrolled. Clinical, biochemical, and virological parameters were assessed every 12 weeks.

Results

In total, 136 patients (median age 49 years, 96 males, 94 HBeAg positive, and 51 with liver cirrhosis) were included. Sixty-two patients were nucleos(t)ide (NA)-naïve, and 74 patients had prior NA therapy (NA-exp group), and 31 patients in the NA-exp group had lamivudine (LAM)-resistance (LAM-R group). The baseline serum hepatitis B virus (HBV) DNA level was 4.9±2.3 log IU/mL (mean±SD), and was higher in the NA-naïve group than in the NA-exp and LAM-R groups (5.9±2.0 log IU/mL vs 3.9±2.0 log IU/mL vs 4.2±1.7 log IU/mL, P<0.01). The complete virological response (CVR) rate at week 48 in the NA-naïve group (71.4%) did not differ significantly from those in the NA-exp (71.3%) and LAM-R (66.1%) groups. In multivariate analysis, baseline serum HBV DNA was the only predictive factor for a CVR at week 48 (hazard ratio, 0.809; 95% confidence interval, 0.729-0.898), while the CVR rate did not differ with the NA experience.

Conclusions

TDF monotherapy was effective for CHB treatment irrespective of prior NA treatment or LAM resistance. Baseline serum HBV DNA was the independent predictive factor for a CVR.     

替诺福韦酯治疗HBeAg阳性慢性乙型肝炎患者的疗效及对肝功能指标的影响

目的探讨替诺福韦酯治疗HBeAg阳性慢性乙型肝炎患者的疗效及对肝功能指标的影响。方法选取2017年2月至2018年3月本院收治的126例HBeAg阳性慢性乙型肝炎患者,按照年龄、性别组间具有可比性原则分为对照组与观察组,各63例。对照组予以恩替卡韦治疗,观察组予以替诺福韦酯治疗,比较两组治疗前后肝功能指标及ALT复常率、HBV DNA转阴率、HBeAg转阴率。结果治疗后,两组AST、ALT、TBiI均低于治疗前,且观察组低于对照组,ALB高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组ALT复常率、HBV DNA阴转率、HBeAg转阴率均高于对照组,差异有统计学意义(P<0.05)。结论相比恩替卡韦治疗,替诺福韦酯治疗HBeAg阳性慢性乙型肝炎患者,可有效改善肝功能,提高HBV DNA阴转率及HBeAg阴转率。     

替诺福韦酯联合双重免疫方案阻断HBV携带孕妇母婴病毒传播效果研究

目的 观察应用替诺福韦酯联合双重免疫方案处理慢性乙型肝炎病毒(HBV)携带孕妇对母婴病毒传播阻断的效果。方法 2016年12月～2019年9月我院收治的HBV携带孕妇120例,采用随机数字表法分为对照组60例和观察组60例。对照组孕妇未进行抗病毒治疗,观察组孕妇在孕26～28个月时开始口服替诺福韦酯,治疗至分娩。所有新生儿出生后立即接种乙肝疫苗和乙型肝炎免疫球蛋白进行双重免疫。采用聚合酶链式反应法检测血清HBV DNA,采用胶体金法检测血清HBsAg和HBeAg。结果 在分娩时,观察组血清ALT水平为(23.2±3.6)IU/L,与对照组【(26.9±4.0)IU/L,P>0.05】比,无显著性差异,血清HBV DNA载量为(3.1±0.7) lg copies/mL,显著低于对照组【(5.9±0.8)lg copies/mL,P<0.05】;观察组新生儿Apgar评分为(9.7±0.3)分,与对照组【(9.9±0.5)分,P>0.05】比,无显著性差异,两组新生儿身高、体质量和头围比较,无显著性差异(P>0.05);在分娩时、出生后6个月和12个月,观察组婴儿HBV感染率为1.7%、1.7%和1.7%,与对照组(分别为11.7%、11.7%和13.3%,P>0.05)比,无显著性差异。结论 应用替诺福韦酯联合双重免疫方案处理HBV携带孕妇及其新生儿能显著降低孕妇血清HBV载量,可能降低婴儿HBV感染率,值得进一步扩大观察。