替诺福韦酯对阿德福韦酯应答不佳患者的挽救治疗研究进展

阿德福韦酯(adefovir dipivoxil,ADV)作为常用抗HBV治疗药物,与拉米夫定(lamivudine,LAM)、替比夫定和恩替卡韦无交叉耐药,且价格相对低廉,长期以来用于初治患者和LAM耐药患者的挽救治疗。然而由于ADV耐药基因屏障较低且临床用药剂量较低,临床长期应用累积了较多ADV应答不佳患者。替诺福韦酯(tenofovir disoproxil fumarate,TDF)作为ADV应答不佳患者的挽救治疗方案之一,对ADV初治应答不佳患者和LAM耐药的ADV应答不佳患者的临床疗效略有差异。然而多项体外研究显示TDF对ADV耐药病毒株抑制作用减弱。ADV应答不佳的患者换用TDF是否会引起或加重肾损害值得临床关注。本文就TDF对ADV应答不佳患者挽救治疗的国内外研究进展作综述,为提高耐药HBV感染防治的管理提供帮助。

Progress in rescue therapy of tenofovir disoproxil fumarate for chronic hepatitis B patients with suboptimal virologic response to adefovir dipivoxil

As the common anti-HBV drug, adefovir dipivoxil (ADV) has been recommended for the rescue therapy of lamivudine-resistant and treat-na?ve patients due to its less cost and no cross-resistance to lamivudine, telbivudine and entecavir. However, since ADV has a lower resistance gene barrier and lower clinical dose, patients with suboptimal virologic response to ADV accumulated during long-term antiviral treatment in clinic. Tenofovir disoproxil fumarate (TDF) has been recommended for the rescue therapy of the patients with suboptimal virologic response to ADV. TDF shows unequal efficacy in lamivudine-experienced and ADV-na?ve patients. And some studiesin vitro reported that ADV resistance mutations reduce susceptibility to TDF. Whether TDF treatment can increase or aggravate the risk of nephrotoxicity for ADV-experienced patients should be concerned in clinical practice. This review aims to summarize progresses in rescue therapy of TDF for chronic HBV-infected patients with suboptimal virologic response to ADV, which will provide help for management of drug-resistant HBV infection.