BACKGROUND Tenofovir disoproxil fumarate(TDF)is a prodrug of a nucleotide analogue.As an antiviral drug,TDF has been proposed in the first-line treatment of chronic hepatitis B(CHB).Qingzhong,a brand name of TDF,comme...BACKGROUND Tenofovir disoproxil fumarate(TDF)is a prodrug of a nucleotide analogue.As an antiviral drug,TDF has been proposed in the first-line treatment of chronic hepatitis B(CHB).Qingzhong,a brand name of TDF,commercialized by Jiangsu Chia-tai Tianqing Pharmaceutical Co Ltd.,and Viread,another brand name of TDF,commercialized by GlaxoSmithKline,have both been approved by the State Food and Drug Administration,China.AIM To investigate the efficacy and safety of the two TDF agents in the treatment of Chinese CHB patients.METHODS This trial was registered at ClinicalTrials.gov with the identifier number of NCT02287857.A total of 330 Chinese CHB patients,among which 232 were hepatitis B e antigen(HBeAg)-positive,were included in this 5-year-long,multicenter,double-blinded,double-dummy,randomized-controlled,noninferiority phase III trial.The participants were initially randomized into two groups:Group A(n=161),in which the participants received 300 mg Qingzhong once a day for 48 wk;and Group B,in which the participants received 300 mg Viread once a day for 48 wk.Starting from week 49,all the participants in Groups A and B received 300 mg Qingzhong once a day until the 96th week.In this study,the primary endpoint was the decrease in plasma level of hepatitis B virus(HBV)DNA at the 96th week,while the secondary endpoints were suppression of HBV replication,alanine aminotransferase(ALT)normalization,HBeAg loss,and HBeAg seroconversion rates.RESULTS For the participants with HBeAg-positive CHB,the decrease in mean HBV DNA level relative to the baseline value was comparable between Groups A and B(5.77 vs 5.73 log10 IU/mL,P>0.05)at the 96th week.In addition,similar percentages of HBeAg-positive participants in the two groups exhibited undetectable levels of HBV DNA,HBeAg loss,and HBeAg seroconversion(71.05%vs 77.97%,31.00%vs 27.27%,and 20.22%vs 15.79%,respectively,in Group A vs Group B;P>0.05).For the participants with HBeAg-negative CHB,the decrease in mean HBV DNA level relative to the baseline value was also comparable between Groups A and B(4.46 vs 4.70 log10 IU/mL,P>0.05)at the 96th week.In addition,similar percentages of HBeAg-negative participants in the two groups exhibited undetectable levels of HBV DNA(87.23%vs 94.12%in Group A vs Group B,respectively;P>0.05).Finally,similar percentages of CHB patients(HBeAg-positive or HBeAg-negative)in the two groups exhibited normalization of ALT(80.14%vs 84.57%in Group A vs Group B,respectively;P>0.05),and similar incidences of adverse events were observed(106 vs 104 in Group A vs Group B,respectively;P>0.05).CONCLUSION Both Qingzhong and Viread are effective and safe in the treatment of Chinese CHB patients according to the results of our clinical trial.展开更多
Purpose: Tenofovir disoproxil fumarate (TEN) and emtricitabine (EMT) are both second generation ant-retroviral drugs used in the “treatment” of HIV/AIDS. The aim of this study is to establish the physic-chemical pro...Purpose: Tenofovir disoproxil fumarate (TEN) and emtricitabine (EMT) are both second generation ant-retroviral drugs used in the “treatment” of HIV/AIDS. The aim of this study is to establish the physic-chemical properties of their reaction with chloranilic acid in different solvent systems and to justify the chemical basis for simultaneous quantitative determination of these drugs in their combined formulation. Method: TEN and EMT were individually isolated from their single formulations and purified by chromatography to obtain secondary standard. Purity of the isolates were tested for by comparison with literature values. Stock solution of chloranilic acid (CA) [3.0 × 10﹣3 M] was prepared in the following solvents of different polarities: ethanol, acetonitrile, ethylacetate, chloroform and hexane. Equal volumes of CA and TEN [3.0 × 10﹣2 M] and EMT [3.0 × 10﹣2 M] dissolved in different solvents were mixed whereby colored products were observed. Absorption maxima were determined. Calibration curves were generated and validated. Quantitative simultaneous determination of TEN and EMT was determined by standard protocol. Stoichiometric relationships between the drugs and CA were established. Equilibrium constants were determined at different temperatures from which the Gibb’s free energies were calculated. Arrhenius equation was used to calculate the enthalpy, entropy was similarly calculated. Results: Absorption maxima of CA in different solvents are as follows: Ethanol 310 nm;Acetonitrile 330 nm;Ethyl acetate 340 nm;Chloroform 350 nm and hexane 310 nm. The complex of CA and TEN in the different solvents are: Alcohol 525 nm, Acetonitrile 500 nm;Ethyl acetate 505 nm;Chloroform 510 nm and hexane 515 nm. For EMT complex absorption maxima are: Alcohol 510 nm;Acetonitrile 515 nm’ Ethyl acetate 520 nm’ Chloroform 505 nm and hexane 530 nm. Simultaneous quantitative recovery values for TEN are: Ethanol;97.89% ± 1.21;Acetonitrile 101.17 V 1.51%;Ethyl acetate 96.55% ± 0.71%;Chloroform 99.11% ± 0.34% and hexane 98.03% ± 0.15%. For EMT the values are also: Ethanol: 98.92% ± 1.45%;Acetonitrile 100.471 ± 13;Ethyl acetate 97.06% ± 0.87%;Chloroform 99.31% ± 0.94% and Hexane 99.97% ± 1.63%. Stoichiometry of complexation showed a 1:1 ratio for both drugs. Equilibrium constants for TEN were highest in acetonitrile and least for Ethanol while for EMT, equilibrium constant was least for acetonitrile and highest in chloroform. Gibb’s free energy for TEN was least in ethanol and highest in acetonitrile. Gibb’s free energy for EMT was least in acetonitrile and highest in chloroform. Enthalpy for TEN was least in chloroform and highest in hexane. Similarly, the enthalpy for EMT was highest in chloroform and lowest in hexane. Conclusion: These results shows that solvent polarity influence charge transfer complexes in a non consistent fashion. The structure of the donor might have contributed to thermodynamics of complexation since orbital overlap may vary from solvent to solvent. For quantitative analysis hexane appears to be the most suitable solvent because it has the highest molar absorptivity and higher enthalpy of interactions. Molecules that can donate electrons and their stereochemistry could contribute to intensity of absorption maxima of the electronic transitions.展开更多
BACKGROUND Both tenofovir alafenamide(TAF)and tenofovir disoproxil fumarate(TDF)are the first-line treatments for chronic hepatitis B(CHB).We have showed switching from TDF to TAF for 96 weeks resulted in further alan...BACKGROUND Both tenofovir alafenamide(TAF)and tenofovir disoproxil fumarate(TDF)are the first-line treatments for chronic hepatitis B(CHB).We have showed switching from TDF to TAF for 96 weeks resulted in further alanine aminotransferase(ALT)improvement,but data remain lacking on the long-term benefits of TDF switching to TAF on hepatic fibrosis.AIM To assess the benefits of TDF switching to TAF for 3 years on ALT,aspartate aminotransferase(AST),and hepatic fibrosis improvement in patients with CHB.METHODS A single center retrospective study on 53 patients with CHB who were initially treated with TDF,then switched to TAF to determine dynamic patterns of ALT,AST,AST to platelet ratio index(APRI),fibrosis-4(FIB-4)scores,and shear wave elastography(SWE)reading improvement at switching week 144,and the associated factors.RESULTS The mean age was 55(28-80);45.3%,males;15.1%,clinical cirrhosis;mean baseline ALT,24.8;AST,25.7 U/L;APRI,0.37;and FIB-4,1.66.After 144 weeks TDF switching to TAF,mean ALT and AST were reduced to 19.7 and 21,respectively.From baseline to switching week 144,the rates of ALT and AST<35(male)/25(female)and<30(male)/19(female)were persistently increased;hepatic fibrosis was also improved by APRI<0.5,from 79.2%to 96.2%;FIB-4<1.45,from 52.8%to 58.5%,respectively;mean APRI was reduced to 0.27;FIB-4,to 1.38;and mean SWE reading,from 7.05 to 6.30 kPa after a mean of 109 weeks switching.The renal function was stable and the frequency of patients with glomerular filtration rate>60 mL/min was increased from 86.5%at baseline to 88.2%at switching week 144.CONCLUSION Our data confirmed that switching from TDF to TAF for 3 years results in not only persistent ALT/AST improvement,but also hepatic fibrosis improvement by APRI,FIB-4 scores,as well as SWE reading,the important clinical benefits of long-term hepatitis B virus antiviral treatment with TAF.展开更多
Little data exist on patients treated with tenofovir in Sub-Saharan Africa. Objective: To describe the clinical and laboratory characteristics of patients with viral hepatitis B treated with tenofovir. Material and me...Little data exist on patients treated with tenofovir in Sub-Saharan Africa. Objective: To describe the clinical and laboratory characteristics of patients with viral hepatitis B treated with tenofovir. Material and methods: A descriptive single-center retrospective study, on chronic viral hepatitis B mono-infected, followed in the hepatogastroenterology department of the University Hospital of Yopougon and treated with tenofovir from February 2012 to February 2015. The studied parameters were demographic, clinical, biochemical, serological, virological, abdominal ultrasound. Liver fibrosis was assessed either by liver biopsy or non-invasive tests. Results: 110 patients were treated with tenofovir disoproxil fumarate with a mean age of 40.4 years and a male predominance. Clinical examination revealed jaundice in 9% of cases, hepatomegaly in 7.3% of cases, splenomegaly in 9.1% of cases and ascites in 15.5% of cases. The AST averaged 77.3 IU/l, the ALT 76.8 IU/l, prothrombin rate at 76.6% , albumin level at 32.3 g/l, total bilirubin at 29.9 g/l, alpha fetoprotein rate at 15.3 ng/ml. HBe antigen was negative in 76.2% of cases. The average rate of DNA at baseline was 7.4 log10 IU/l. 27.5% was cirrhotic. The average time of starting treatment was 23.7 months. Conclusion: TDF is the first-line treatment for chronic hepatitis B in our country, because it is a well-tolerated, potent therapy with a high threshold for resistance development. Our study population had an average age of 40.4 years. Virological profile was dominated by HBe antigen negative patients and high viral load of HVB DNA. One third of patients were at the stage of cirrhosis. This treatment must be delivered free of charge in all the country hospitals, which is going to improve significantly the natural evolution of the disease and to decrease the incidence of the HCC.展开更多
Introduction: In this study, physical and chemical characteristics of Lamivudine, Tenofovir Disoproxil Fumarate (TDF) and potential excipients were systematically followed and documented [1]. Objective: The objective ...Introduction: In this study, physical and chemical characteristics of Lamivudine, Tenofovir Disoproxil Fumarate (TDF) and potential excipients were systematically followed and documented [1]. Objective: The objective of this scientific work was to carry out pre-formulation studies including compatibility studies on Lamivudine and Tenofovir Disoproxil Fumarate with their potential excipients prior a direct compression process [2]. Methodology: The interaction was studied in three set of environments namely uncontrolled room conditions for Zone VI b (30°C ± 2°C), oven conditions in which the oven was set at 50°C and accelerated climatic conditions in which a climatic chamber was set at 40°C ± 2°C/75% ± 5% Relative Humidity (RH %). Sample preparation was done by mixing the amount of formulation excipients to active substances at a ratio of 1:10, whereas active substance to another active substance at a ratio of 1:1, active substance to coating materials at 1:4, coating materials to the whole set of excipients 1:4. The whole set of samples was geometrically mixed and triturated by mortar and pestle to very fine uniform powder to ensure homogeneity of the mixture. HPLC analytical method was used for simultaneous quantitative determination of lamivudine and tenofovir disoproxil fumarate. Transmittance of the mixture was determined by Near Infra-Red (NIR) technique. Results: The amount of Lamivudine as on day 0 was comparable to day 90 for in all tested conditions (Room, Oven and Climatic Chamber), whereas for Tenofovir Disoproxil Fumarate only the amount of the drug at Room (30°C ± 2°C) was comparable to results on day 90. A significant drop of amount of Tenofovir Disoproxil Fumarate (TDF) exposed to moisture (Climatic chamber at 40°C ± 2°C/75% ± 5% Relative Humidity (RH %)) and temperature of 50°C was observed. Colour change was observed for samples subjected to moisture (Climatic chamber at 40°C ± 2°C/75% ± 5% Relative Humidity (RH %)) and as well picked up in the NIR region 400 to 1500 cm<sup>-1</sup> (Finger print region) by a significant shift in Transmittance. Conclusion: It can be concluded that microcrystalline cellulose, cross linked sodium carboxymethyl cellulose, magnesium stearate and sodium carbxymethyl cellulose can be compressed together with Lamivudine and Tenofovir Disoproxil Fumarate (TDF) to produce a pharmaceutically acceptable solid dosage form, tablet. The produced tablets should be packed in moisture and light protective containers as Tenofovir Disoproxil Fumarate (TDF) has diester linkages which can be hydrolysed into the active drug Tenofovir in the presence of moisture.展开更多
The coronavirus disease 2019(COVID-19)pandemic continues worldwide.We report here two cases of chronic hepatitis B patients with acute respiratory syndrome coronavirus 2 infection treated with tenofovir disoproxil fum...The coronavirus disease 2019(COVID-19)pandemic continues worldwide.We report here two cases of chronic hepatitis B patients with acute respiratory syndrome coronavirus 2 infection treated with tenofovir disoproxil fumarate who demonstrated a favorable outcome.This report adds some evidence that concurrent HBV infection may not worsen COVID-19 infection and tenofovir disoproxil fumarate treatment may have partial positive effect on COVID-19 rapid recovery.展开更多
Tenofovir alafenamide fumarate(TAF)has been endorsed by guidelines for blockade ofmother-to-child transmission of hepatitis B virus(HBV),given that its efficacy and safety are comparable to tenofovir disoproxil fumara...Tenofovir alafenamide fumarate(TAF)has been endorsed by guidelines for blockade ofmother-to-child transmission of hepatitis B virus(HBV),given that its efficacy and safety are comparable to tenofovir disoproxil fumarate(TDF).However,there is a lack of comparative studies regarding the treatment efficacy in patients with diverse viral loads.This study retrospectively analyzed 96 hepatitis B e antigen(HBeAg)–positive pregnant women with HBV DNA levels of≥2×10^(5) IU/mL.Based on viral loads(HBV DNA levels),participants in the TAF and TDF groups were stratified into three subgroups,namely,the High-G(titer≥8 log_(10) IU/mL),Middle-G(7 log_(10) IU/mL≤titer<8 log_(10) IU/mL)and Low-G(titer<7 log_(10) IU/mL)subgroups.The primary endpoint was effectiveness of TAF and TDF in patients with varying viral loads,whereas secondary endpoints were hepatitis B surface antigen(HBsAg)positivity in infants at 7 to 12 months and the safety profile for mothers and children.Compared with baseline levels,median HBV DNA levels in mothers were decreased by 4.51 and 4.09 log_(10) IU/mL in the TAF andTDF groups(P=0.04)predelivery,respectively.In the High-G subgroup,the titers were significantly lower in the TAF group(P=0.045).A higher proportion of patients experienced a virus decline of≥4 log_(10) IU/mL in the TAF group compared with the TDF group,with rates of 78.26% versus 58%(P=0.034),respectively.Moreover,the median serum phosphate levels significantly decreased frombaseline to predelivery in the TDF group(P=0.04).Finally,infants in both cohorts tested negative for HBsAg at 7–12 months after delivery.Overall,our findings indicate that TAF can be considered the preferred option for the treatment of HBeAgpositive pregnant women with HBV DNA levels of≥8 log_(10) IU/mL.展开更多
Background:The role of different genotypes in nucleos(t)ide analogs(NAs)treatment is still debated.Previous studies conducted on special populations evidenced that the E genotype had the lower virological and serologi...Background:The role of different genotypes in nucleos(t)ide analogs(NAs)treatment is still debated.Previous studies conducted on special populations evidenced that the E genotype had the lower virological and serological response.This descriptive study aims to recognize the hepatitis B“s”antigen(HBsAg)decline during tenofovir disoproxil fumarate(TDF)treatment in a cohort of patient affected by chronic hepatitis B(CHB).Methods:We retrospectively included all patients with CHB treated with TDF between April 2007 and March 2012 with a duration of treatment of 7 years.Kinetics of HBsAg was determined as serological response in this cohort.We include 110 subjects;virological response was observed in all subjects with genotypes A,B,and D;in 17 patients with C genotype(94.4%)and 24 with E genotype(96%).HBeAg loss was observed in 2 patients with genotype A(50%),3 with B(100%),0 with C(0%),1 with D(20%),and 1 with E genotype(25%).Results:In multivariate analysis we observed as predictive factors of HBsAg decline the baseline level of HBsAg(OR=1.467;95%CI:1.221–5.113;p=0.017)and viral genotypes(OR=11.218;95%CI:5.441–41.138;p<0.001).Conclusion:This study confirmed higher HBsAg decline after 7 years of treatment in A and B genotypes,and lower in C,E,and D genotypes.However,no evidence is enough to choose a single NAs,but in special populations,as well as in genotype E,the use of TDF should be preferred to entecavir.展开更多
Background and aims:Antiviral therapy is essential for hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).No data are available on the long-term prognosis or safety of tenofovir alafenamide(TAF),tenofo...Background and aims:Antiviral therapy is essential for hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).No data are available on the long-term prognosis or safety of tenofovir alafenamide(TAF),tenofovir disoproxil fumarate(TDF),or entecavir(ETV)in treating HBV-ACLF globally.This study was conducted to investigate the long-term efficacy and safety of the three nucleos(t)ide analogs in the treatment of HBV-ACLF.Methods:In this prospective,real-world cohort study,patients with HBV-ACLF were assigned to the TAF,TDF,and ETV groups.A total of 199 patients completed the 144-week follow-up.After propensity score matching(PSM),44 patients remained in each group for further analysis of survival status,incidence of hepatocellular carcinoma(HCC),virological response,and liver and renal function indicators.Results:In the original cohort,HCC developed in one patient in each group.No serious drug-related adverse events were observed.In the PSM cohort,the 144-week survival rates were 56.82%,75.00%,and 59.09%in the TAF,TDF,and ETV groups,respectively(P=0.118).When stratified into noncirrhosis and cirrhosis subgroups at baseline,the survival rate of the ETV group was slightly lower than that of the TAF and TDF group in noncirrhosis patients(P=0.338),and the survival rate of the TAF group was slightly lower than that of the TDF and ETV group in cirrhosis patients(P=0.052),but the differences were not statistically significant.The long-term overall survival rates in the TAF,TDF,and ETV groups were comparable.After 144 weeks,no significant difference in the virological response rate or liver or renal function indicators was found among the three groups,except for the level of aspartate aminotransferase,which was significantly higher in the TDF group than in the ETV group at week 144(P=0.001).Conclusions:There were no significant differences in the survival rate,incidence of HCC,efficacy or safety associated with the use of these three nucleos(t)ide analogs in treating HBV-ACLF.展开更多
In patients with chronic hepatitis B(CHB),entecavir(ETV)and tenofovir disoproxil fumarate(TDF)are equally recommended as first-line treatment by the international guidelines.These two drugs have shown similar short an...In patients with chronic hepatitis B(CHB),entecavir(ETV)and tenofovir disoproxil fumarate(TDF)are equally recommended as first-line treatment by the international guidelines.These two drugs have shown similar short and intermediate clinical outcomes,including virologic,biochemical,and histologic responses.However,there is considerable controversy as to whether ETV and TDF differ in reducing the risk of hepatocellular carcinoma(HCC)in patients with CHB despite many observational studies and meta-analyses being published.In this review,we summarize recent evidence comparing the preventive effects of these two drugs against HCC from the perspective that TDF is associated with a lower risk of HCC compared with ETV in patients with CHB.展开更多
目的评价符合入排条件的接受EFV+3TC+TDF方案的HIV-1感染者转换为艾诺米替(艾诺韦林/拉米夫定/替诺福韦,ANV/3TC/TDF)治疗144周,以及EFV+3TC+TDF转换艾考恩丙替(艾维雷韦/考比司他/恩曲他滨/丙酚替诺福韦,EVG/c/FTC/TAF)治疗48周后,继...目的评价符合入排条件的接受EFV+3TC+TDF方案的HIV-1感染者转换为艾诺米替(艾诺韦林/拉米夫定/替诺福韦,ANV/3TC/TDF)治疗144周,以及EFV+3TC+TDF转换艾考恩丙替(艾维雷韦/考比司他/恩曲他滨/丙酚替诺福韦,EVG/c/FTC/TAF)治疗48周后,继续转换为ANV/3TC/TDF治疗至144周的有效性和代谢安全性。方法本研究为SPRINT(Switching people with HIV to receive innovative NNRTI-based therapy)研究的拓展性用药研究,将研究对象分为即刻转换组(指ANV/3TC/TDF自基线治疗至第144周)和延迟转换组(指EVG/c/FTC/TAF自基线治疗48周后,转换为ANV/3TC/TDF治疗至第144周)。研究的有效性终点为治疗144周时HIV-1病毒得到抑制的研究对象百分比,代谢安全性结局包括低密度脂蛋白胆固醇(LDL-C)、动脉粥样硬化性心血管疾病(ASCVD)风险相关LDL-C分层,估计肾小球滤过率(eGFR)用于评估肾功能安全性。结果研究共纳入731例研究对象,其中即刻转换组370例,延迟转换组361例。治疗144周时,即刻转换组与延迟转换组的研究对象病毒学抑制百分比分别为95.3%与95%,两组的CD4细胞计数自48周到144周分别上升(70.9±8.7)与(64.4±9.7)个/μL。延迟转换组的LDL-C值由于经历了0到48周上升过程,在48到144周时的降幅显著大于即刻转换组(-0.44±0.03 vs.-0.06±0.03 mmol/L,P<0.001),两组LDL-C高风险分层百分比自基线到144周分别下降60.0%和78.1%。治疗144周时两组eGFR值分别为(109.1±20.4)mL/min/1.73 m^(2)与(106.3±13.9)mL/min/1.73 m^(2),组间差异无统计学意义(P>0.05)。结论EFV为核心的cART方案以及含TAF的整合酶抑制剂(INSTIs)方案转换为ANV/3TC/TDF均可实现持续病毒学抑制,同时持续改善LDL-C水平及ASCVD风险分层。由含TAF的INSTIs方案转换为ANV/3TC/TDF方案后,可显著降低LDL-C异常的研究对象比例。展开更多
BACKGROUND Entecavir(ETV)and tenofovir fumarate(TDF)are recommended first-line agents for the treatment of chronic hepatitis B virus(HBV)infection.However,the effect of these 2 antiviral agents on the risk for recurre...BACKGROUND Entecavir(ETV)and tenofovir fumarate(TDF)are recommended first-line agents for the treatment of chronic hepatitis B virus(HBV)infection.However,the effect of these 2 antiviral agents on the risk for recurrence of HBV-associated hepato-cellular carcinoma(HCC)after radical hepatectomy remains controversial.AIM To compare the effect of TDF vs ETV on the risk for HCC recurrence after radical surgery for HBV-related HCC.METHODS Data from consecutive patients,who received TDF or ETV after radical hepatec-tomy for HBV-related HCC and admitted to the Second Hospital of Longyan between December 2018 and December 2023,were retrospectively analyzed.Based on treatment method and propensity score matching(PSM),data from 100 patients were included,with 50 in each of the TDF and ETV groups,respectively.The baseline characteristics of the 2 groups were analyzed,and the risk for HCC recurrence was compared between the groups.RESULTS The median follow-up for 100 patients[median age,61 years;84 male(84%)]who underwent radical resection for HBV-related HCC-Barcelona Clinic Liver Cancer stage 0[n=16(16%)],stage A[n=61(61%)]-was 29 months(range,12-60 months);the median tumor size was 3.0 cm(range,2.1-4.3 cm).Sixty-eight(68%)patients exhibited HBV-DNA levels>1000 IU/mL.Twenty-two(22%)patients tested positive for hepatitis B e antigen,in whom the HCC recurrence rate was 59.1%(13/22).After PSM,HCC recurrence rates in the ETV and TDF groups after hepatectomy were 66%(n=33)and 42%(n=21),respectively(P=0.016),and cumulative recurrence rates at 1,3,and 5 years were 26%,58%,and 66%,and 18%,38%,and 42%,respectively(P=0.045).CONCLUSION TDF treatment is associated with a lower risk for HCC-related outcomes than that for ETV in patients with HBV-associated HCC after curative therapy.展开更多
BACKGROUND Tenofovir alafenamide fumarate(TAF)is one of the first-line treatments used to treat chronic hepatitis B patients;TAF has strong antiviral activity and a high barrier to resistance.Although virological brea...BACKGROUND Tenofovir alafenamide fumarate(TAF)is one of the first-line treatments used to treat chronic hepatitis B patients;TAF has strong antiviral activity and a high barrier to resistance.Although virological breakthroughs in patients during TAF treatment are rare,patients with incomplete responses to TAF are occasionally observed.AIM To investigate responsible mutations in the reverse transcriptase region of hepatitis B virus(HBV)for TAF-incomplete responses.METHODS Thirteen chronic hepatitis B patients who received TAF monotherapy were included.A TAF-incomplete responder was defined as one who was continuously positive for HBV DNA over 2 years after TAF treatment initiation.The emergences of mutations in TAF-incomplete responders were evaluated before,one year after,and two years after treatment by deep sequencing of HBV DNA and RNA.RESULTS Two patients were continuously positive for HBV DNA over two years.The rtL269I mutation,one of the CYEI mutations linked to tenofovir resistance,was detected in both patients by direct sequencing.The deep sequencing analysis revealed that a combination of rtT118A and rtL220I mutations and the rtL269I mutation were predominantly detected in HBV DNA even when these mutations were barely detected in HBV RNA.This suggests a superior replication capability of the HBV variants with these mutations under TAF treatment.CONCLUSION The deep sequencing analysis of HBV DNA and RNA and comparing the detection rates of mutations were useful for estimating responsible mutations for TAF-incomplete responses.Such analysis is needed to evaluate the association between mutations that emerge during TAF treatment and incomplete responses to TAF.展开更多
基金Supported by The 13th Five-year Science and Technology Major Project of China,on the Prevention and Treatment of Major Infectious Diseases,No.2017ZX10202202.
文摘BACKGROUND Tenofovir disoproxil fumarate(TDF)is a prodrug of a nucleotide analogue.As an antiviral drug,TDF has been proposed in the first-line treatment of chronic hepatitis B(CHB).Qingzhong,a brand name of TDF,commercialized by Jiangsu Chia-tai Tianqing Pharmaceutical Co Ltd.,and Viread,another brand name of TDF,commercialized by GlaxoSmithKline,have both been approved by the State Food and Drug Administration,China.AIM To investigate the efficacy and safety of the two TDF agents in the treatment of Chinese CHB patients.METHODS This trial was registered at ClinicalTrials.gov with the identifier number of NCT02287857.A total of 330 Chinese CHB patients,among which 232 were hepatitis B e antigen(HBeAg)-positive,were included in this 5-year-long,multicenter,double-blinded,double-dummy,randomized-controlled,noninferiority phase III trial.The participants were initially randomized into two groups:Group A(n=161),in which the participants received 300 mg Qingzhong once a day for 48 wk;and Group B,in which the participants received 300 mg Viread once a day for 48 wk.Starting from week 49,all the participants in Groups A and B received 300 mg Qingzhong once a day until the 96th week.In this study,the primary endpoint was the decrease in plasma level of hepatitis B virus(HBV)DNA at the 96th week,while the secondary endpoints were suppression of HBV replication,alanine aminotransferase(ALT)normalization,HBeAg loss,and HBeAg seroconversion rates.RESULTS For the participants with HBeAg-positive CHB,the decrease in mean HBV DNA level relative to the baseline value was comparable between Groups A and B(5.77 vs 5.73 log10 IU/mL,P>0.05)at the 96th week.In addition,similar percentages of HBeAg-positive participants in the two groups exhibited undetectable levels of HBV DNA,HBeAg loss,and HBeAg seroconversion(71.05%vs 77.97%,31.00%vs 27.27%,and 20.22%vs 15.79%,respectively,in Group A vs Group B;P>0.05).For the participants with HBeAg-negative CHB,the decrease in mean HBV DNA level relative to the baseline value was also comparable between Groups A and B(4.46 vs 4.70 log10 IU/mL,P>0.05)at the 96th week.In addition,similar percentages of HBeAg-negative participants in the two groups exhibited undetectable levels of HBV DNA(87.23%vs 94.12%in Group A vs Group B,respectively;P>0.05).Finally,similar percentages of CHB patients(HBeAg-positive or HBeAg-negative)in the two groups exhibited normalization of ALT(80.14%vs 84.57%in Group A vs Group B,respectively;P>0.05),and similar incidences of adverse events were observed(106 vs 104 in Group A vs Group B,respectively;P>0.05).CONCLUSION Both Qingzhong and Viread are effective and safe in the treatment of Chinese CHB patients according to the results of our clinical trial.
文摘Purpose: Tenofovir disoproxil fumarate (TEN) and emtricitabine (EMT) are both second generation ant-retroviral drugs used in the “treatment” of HIV/AIDS. The aim of this study is to establish the physic-chemical properties of their reaction with chloranilic acid in different solvent systems and to justify the chemical basis for simultaneous quantitative determination of these drugs in their combined formulation. Method: TEN and EMT were individually isolated from their single formulations and purified by chromatography to obtain secondary standard. Purity of the isolates were tested for by comparison with literature values. Stock solution of chloranilic acid (CA) [3.0 × 10﹣3 M] was prepared in the following solvents of different polarities: ethanol, acetonitrile, ethylacetate, chloroform and hexane. Equal volumes of CA and TEN [3.0 × 10﹣2 M] and EMT [3.0 × 10﹣2 M] dissolved in different solvents were mixed whereby colored products were observed. Absorption maxima were determined. Calibration curves were generated and validated. Quantitative simultaneous determination of TEN and EMT was determined by standard protocol. Stoichiometric relationships between the drugs and CA were established. Equilibrium constants were determined at different temperatures from which the Gibb’s free energies were calculated. Arrhenius equation was used to calculate the enthalpy, entropy was similarly calculated. Results: Absorption maxima of CA in different solvents are as follows: Ethanol 310 nm;Acetonitrile 330 nm;Ethyl acetate 340 nm;Chloroform 350 nm and hexane 310 nm. The complex of CA and TEN in the different solvents are: Alcohol 525 nm, Acetonitrile 500 nm;Ethyl acetate 505 nm;Chloroform 510 nm and hexane 515 nm. For EMT complex absorption maxima are: Alcohol 510 nm;Acetonitrile 515 nm’ Ethyl acetate 520 nm’ Chloroform 505 nm and hexane 530 nm. Simultaneous quantitative recovery values for TEN are: Ethanol;97.89% ± 1.21;Acetonitrile 101.17 V 1.51%;Ethyl acetate 96.55% ± 0.71%;Chloroform 99.11% ± 0.34% and hexane 98.03% ± 0.15%. For EMT the values are also: Ethanol: 98.92% ± 1.45%;Acetonitrile 100.471 ± 13;Ethyl acetate 97.06% ± 0.87%;Chloroform 99.31% ± 0.94% and Hexane 99.97% ± 1.63%. Stoichiometry of complexation showed a 1:1 ratio for both drugs. Equilibrium constants for TEN were highest in acetonitrile and least for Ethanol while for EMT, equilibrium constant was least for acetonitrile and highest in chloroform. Gibb’s free energy for TEN was least in ethanol and highest in acetonitrile. Gibb’s free energy for EMT was least in acetonitrile and highest in chloroform. Enthalpy for TEN was least in chloroform and highest in hexane. Similarly, the enthalpy for EMT was highest in chloroform and lowest in hexane. Conclusion: These results shows that solvent polarity influence charge transfer complexes in a non consistent fashion. The structure of the donor might have contributed to thermodynamics of complexation since orbital overlap may vary from solvent to solvent. For quantitative analysis hexane appears to be the most suitable solvent because it has the highest molar absorptivity and higher enthalpy of interactions. Molecules that can donate electrons and their stereochemistry could contribute to intensity of absorption maxima of the electronic transitions.
文摘BACKGROUND Both tenofovir alafenamide(TAF)and tenofovir disoproxil fumarate(TDF)are the first-line treatments for chronic hepatitis B(CHB).We have showed switching from TDF to TAF for 96 weeks resulted in further alanine aminotransferase(ALT)improvement,but data remain lacking on the long-term benefits of TDF switching to TAF on hepatic fibrosis.AIM To assess the benefits of TDF switching to TAF for 3 years on ALT,aspartate aminotransferase(AST),and hepatic fibrosis improvement in patients with CHB.METHODS A single center retrospective study on 53 patients with CHB who were initially treated with TDF,then switched to TAF to determine dynamic patterns of ALT,AST,AST to platelet ratio index(APRI),fibrosis-4(FIB-4)scores,and shear wave elastography(SWE)reading improvement at switching week 144,and the associated factors.RESULTS The mean age was 55(28-80);45.3%,males;15.1%,clinical cirrhosis;mean baseline ALT,24.8;AST,25.7 U/L;APRI,0.37;and FIB-4,1.66.After 144 weeks TDF switching to TAF,mean ALT and AST were reduced to 19.7 and 21,respectively.From baseline to switching week 144,the rates of ALT and AST<35(male)/25(female)and<30(male)/19(female)were persistently increased;hepatic fibrosis was also improved by APRI<0.5,from 79.2%to 96.2%;FIB-4<1.45,from 52.8%to 58.5%,respectively;mean APRI was reduced to 0.27;FIB-4,to 1.38;and mean SWE reading,from 7.05 to 6.30 kPa after a mean of 109 weeks switching.The renal function was stable and the frequency of patients with glomerular filtration rate>60 mL/min was increased from 86.5%at baseline to 88.2%at switching week 144.CONCLUSION Our data confirmed that switching from TDF to TAF for 3 years results in not only persistent ALT/AST improvement,but also hepatic fibrosis improvement by APRI,FIB-4 scores,as well as SWE reading,the important clinical benefits of long-term hepatitis B virus antiviral treatment with TAF.
文摘Little data exist on patients treated with tenofovir in Sub-Saharan Africa. Objective: To describe the clinical and laboratory characteristics of patients with viral hepatitis B treated with tenofovir. Material and methods: A descriptive single-center retrospective study, on chronic viral hepatitis B mono-infected, followed in the hepatogastroenterology department of the University Hospital of Yopougon and treated with tenofovir from February 2012 to February 2015. The studied parameters were demographic, clinical, biochemical, serological, virological, abdominal ultrasound. Liver fibrosis was assessed either by liver biopsy or non-invasive tests. Results: 110 patients were treated with tenofovir disoproxil fumarate with a mean age of 40.4 years and a male predominance. Clinical examination revealed jaundice in 9% of cases, hepatomegaly in 7.3% of cases, splenomegaly in 9.1% of cases and ascites in 15.5% of cases. The AST averaged 77.3 IU/l, the ALT 76.8 IU/l, prothrombin rate at 76.6% , albumin level at 32.3 g/l, total bilirubin at 29.9 g/l, alpha fetoprotein rate at 15.3 ng/ml. HBe antigen was negative in 76.2% of cases. The average rate of DNA at baseline was 7.4 log10 IU/l. 27.5% was cirrhotic. The average time of starting treatment was 23.7 months. Conclusion: TDF is the first-line treatment for chronic hepatitis B in our country, because it is a well-tolerated, potent therapy with a high threshold for resistance development. Our study population had an average age of 40.4 years. Virological profile was dominated by HBe antigen negative patients and high viral load of HVB DNA. One third of patients were at the stage of cirrhosis. This treatment must be delivered free of charge in all the country hospitals, which is going to improve significantly the natural evolution of the disease and to decrease the incidence of the HCC.
文摘Introduction: In this study, physical and chemical characteristics of Lamivudine, Tenofovir Disoproxil Fumarate (TDF) and potential excipients were systematically followed and documented [1]. Objective: The objective of this scientific work was to carry out pre-formulation studies including compatibility studies on Lamivudine and Tenofovir Disoproxil Fumarate with their potential excipients prior a direct compression process [2]. Methodology: The interaction was studied in three set of environments namely uncontrolled room conditions for Zone VI b (30°C ± 2°C), oven conditions in which the oven was set at 50°C and accelerated climatic conditions in which a climatic chamber was set at 40°C ± 2°C/75% ± 5% Relative Humidity (RH %). Sample preparation was done by mixing the amount of formulation excipients to active substances at a ratio of 1:10, whereas active substance to another active substance at a ratio of 1:1, active substance to coating materials at 1:4, coating materials to the whole set of excipients 1:4. The whole set of samples was geometrically mixed and triturated by mortar and pestle to very fine uniform powder to ensure homogeneity of the mixture. HPLC analytical method was used for simultaneous quantitative determination of lamivudine and tenofovir disoproxil fumarate. Transmittance of the mixture was determined by Near Infra-Red (NIR) technique. Results: The amount of Lamivudine as on day 0 was comparable to day 90 for in all tested conditions (Room, Oven and Climatic Chamber), whereas for Tenofovir Disoproxil Fumarate only the amount of the drug at Room (30°C ± 2°C) was comparable to results on day 90. A significant drop of amount of Tenofovir Disoproxil Fumarate (TDF) exposed to moisture (Climatic chamber at 40°C ± 2°C/75% ± 5% Relative Humidity (RH %)) and temperature of 50°C was observed. Colour change was observed for samples subjected to moisture (Climatic chamber at 40°C ± 2°C/75% ± 5% Relative Humidity (RH %)) and as well picked up in the NIR region 400 to 1500 cm<sup>-1</sup> (Finger print region) by a significant shift in Transmittance. Conclusion: It can be concluded that microcrystalline cellulose, cross linked sodium carboxymethyl cellulose, magnesium stearate and sodium carbxymethyl cellulose can be compressed together with Lamivudine and Tenofovir Disoproxil Fumarate (TDF) to produce a pharmaceutically acceptable solid dosage form, tablet. The produced tablets should be packed in moisture and light protective containers as Tenofovir Disoproxil Fumarate (TDF) has diester linkages which can be hydrolysed into the active drug Tenofovir in the presence of moisture.
基金This work was supported by the Applied Basic and Frontier Technology Research Project of Wuhan(grant no.2020020601012233)the Fundamental Research Funds for the Central Universities(grant no.2020kfyXGYJ016).
文摘The coronavirus disease 2019(COVID-19)pandemic continues worldwide.We report here two cases of chronic hepatitis B patients with acute respiratory syndrome coronavirus 2 infection treated with tenofovir disoproxil fumarate who demonstrated a favorable outcome.This report adds some evidence that concurrent HBV infection may not worsen COVID-19 infection and tenofovir disoproxil fumarate treatment may have partial positive effect on COVID-19 rapid recovery.
基金supported by the Key Project of Hangzhou Science and Technology Bureau of Agriculture and Social Development Scientific Research(2022A04A02)Zhejiang Province Medical and Health Research Project(2018KY628)Hangzhou City Social Development Scientific Research Active Design Project(20172016A03).
文摘Tenofovir alafenamide fumarate(TAF)has been endorsed by guidelines for blockade ofmother-to-child transmission of hepatitis B virus(HBV),given that its efficacy and safety are comparable to tenofovir disoproxil fumarate(TDF).However,there is a lack of comparative studies regarding the treatment efficacy in patients with diverse viral loads.This study retrospectively analyzed 96 hepatitis B e antigen(HBeAg)–positive pregnant women with HBV DNA levels of≥2×10^(5) IU/mL.Based on viral loads(HBV DNA levels),participants in the TAF and TDF groups were stratified into three subgroups,namely,the High-G(titer≥8 log_(10) IU/mL),Middle-G(7 log_(10) IU/mL≤titer<8 log_(10) IU/mL)and Low-G(titer<7 log_(10) IU/mL)subgroups.The primary endpoint was effectiveness of TAF and TDF in patients with varying viral loads,whereas secondary endpoints were hepatitis B surface antigen(HBsAg)positivity in infants at 7 to 12 months and the safety profile for mothers and children.Compared with baseline levels,median HBV DNA levels in mothers were decreased by 4.51 and 4.09 log_(10) IU/mL in the TAF andTDF groups(P=0.04)predelivery,respectively.In the High-G subgroup,the titers were significantly lower in the TAF group(P=0.045).A higher proportion of patients experienced a virus decline of≥4 log_(10) IU/mL in the TAF group compared with the TDF group,with rates of 78.26% versus 58%(P=0.034),respectively.Moreover,the median serum phosphate levels significantly decreased frombaseline to predelivery in the TDF group(P=0.04).Finally,infants in both cohorts tested negative for HBsAg at 7–12 months after delivery.Overall,our findings indicate that TAF can be considered the preferred option for the treatment of HBeAgpositive pregnant women with HBV DNA levels of≥8 log_(10) IU/mL.
文摘Background:The role of different genotypes in nucleos(t)ide analogs(NAs)treatment is still debated.Previous studies conducted on special populations evidenced that the E genotype had the lower virological and serological response.This descriptive study aims to recognize the hepatitis B“s”antigen(HBsAg)decline during tenofovir disoproxil fumarate(TDF)treatment in a cohort of patient affected by chronic hepatitis B(CHB).Methods:We retrospectively included all patients with CHB treated with TDF between April 2007 and March 2012 with a duration of treatment of 7 years.Kinetics of HBsAg was determined as serological response in this cohort.We include 110 subjects;virological response was observed in all subjects with genotypes A,B,and D;in 17 patients with C genotype(94.4%)and 24 with E genotype(96%).HBeAg loss was observed in 2 patients with genotype A(50%),3 with B(100%),0 with C(0%),1 with D(20%),and 1 with E genotype(25%).Results:In multivariate analysis we observed as predictive factors of HBsAg decline the baseline level of HBsAg(OR=1.467;95%CI:1.221–5.113;p=0.017)and viral genotypes(OR=11.218;95%CI:5.441–41.138;p<0.001).Conclusion:This study confirmed higher HBsAg decline after 7 years of treatment in A and B genotypes,and lower in C,E,and D genotypes.However,no evidence is enough to choose a single NAs,but in special populations,as well as in genotype E,the use of TDF should be preferred to entecavir.
基金supported by grants from Key-Area Research and Development Program of Guangdong Province(No.2020B0101130015)Guangdong Medical Science and Technology Research Fund(No.A2021304)+5 种基金the Natural Science Foundation of China(No.82070611)Guangzhou Science and Technology Plan Projects(No.2023B03J1287)Guangzhou Science and Technology Program Key Projects(No.2023B01J1007)Sun Yat-Sen University Clinical Research 5010 Program(No.2020007)the Five-Year Plan of Third Affiliated Hospital of Sun Yat-sen University(No.2023W106)Clinical trial number:ClinicalTrials.gov ID:NCT03920618.
文摘Background and aims:Antiviral therapy is essential for hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).No data are available on the long-term prognosis or safety of tenofovir alafenamide(TAF),tenofovir disoproxil fumarate(TDF),or entecavir(ETV)in treating HBV-ACLF globally.This study was conducted to investigate the long-term efficacy and safety of the three nucleos(t)ide analogs in the treatment of HBV-ACLF.Methods:In this prospective,real-world cohort study,patients with HBV-ACLF were assigned to the TAF,TDF,and ETV groups.A total of 199 patients completed the 144-week follow-up.After propensity score matching(PSM),44 patients remained in each group for further analysis of survival status,incidence of hepatocellular carcinoma(HCC),virological response,and liver and renal function indicators.Results:In the original cohort,HCC developed in one patient in each group.No serious drug-related adverse events were observed.In the PSM cohort,the 144-week survival rates were 56.82%,75.00%,and 59.09%in the TAF,TDF,and ETV groups,respectively(P=0.118).When stratified into noncirrhosis and cirrhosis subgroups at baseline,the survival rate of the ETV group was slightly lower than that of the TAF and TDF group in noncirrhosis patients(P=0.338),and the survival rate of the TAF group was slightly lower than that of the TDF and ETV group in cirrhosis patients(P=0.052),but the differences were not statistically significant.The long-term overall survival rates in the TAF,TDF,and ETV groups were comparable.After 144 weeks,no significant difference in the virological response rate or liver or renal function indicators was found among the three groups,except for the level of aspartate aminotransferase,which was significantly higher in the TDF group than in the ETV group at week 144(P=0.001).Conclusions:There were no significant differences in the survival rate,incidence of HCC,efficacy or safety associated with the use of these three nucleos(t)ide analogs in treating HBV-ACLF.
基金supported by The Research Supporting Program of The Korean Association for the Study of the Liver and The Korean Liver Foundation.
文摘In patients with chronic hepatitis B(CHB),entecavir(ETV)and tenofovir disoproxil fumarate(TDF)are equally recommended as first-line treatment by the international guidelines.These two drugs have shown similar short and intermediate clinical outcomes,including virologic,biochemical,and histologic responses.However,there is considerable controversy as to whether ETV and TDF differ in reducing the risk of hepatocellular carcinoma(HCC)in patients with CHB despite many observational studies and meta-analyses being published.In this review,we summarize recent evidence comparing the preventive effects of these two drugs against HCC from the perspective that TDF is associated with a lower risk of HCC compared with ETV in patients with CHB.
文摘目的评价符合入排条件的接受EFV+3TC+TDF方案的HIV-1感染者转换为艾诺米替(艾诺韦林/拉米夫定/替诺福韦,ANV/3TC/TDF)治疗144周,以及EFV+3TC+TDF转换艾考恩丙替(艾维雷韦/考比司他/恩曲他滨/丙酚替诺福韦,EVG/c/FTC/TAF)治疗48周后,继续转换为ANV/3TC/TDF治疗至144周的有效性和代谢安全性。方法本研究为SPRINT(Switching people with HIV to receive innovative NNRTI-based therapy)研究的拓展性用药研究,将研究对象分为即刻转换组(指ANV/3TC/TDF自基线治疗至第144周)和延迟转换组(指EVG/c/FTC/TAF自基线治疗48周后,转换为ANV/3TC/TDF治疗至第144周)。研究的有效性终点为治疗144周时HIV-1病毒得到抑制的研究对象百分比,代谢安全性结局包括低密度脂蛋白胆固醇(LDL-C)、动脉粥样硬化性心血管疾病(ASCVD)风险相关LDL-C分层,估计肾小球滤过率(eGFR)用于评估肾功能安全性。结果研究共纳入731例研究对象,其中即刻转换组370例,延迟转换组361例。治疗144周时,即刻转换组与延迟转换组的研究对象病毒学抑制百分比分别为95.3%与95%,两组的CD4细胞计数自48周到144周分别上升(70.9±8.7)与(64.4±9.7)个/μL。延迟转换组的LDL-C值由于经历了0到48周上升过程,在48到144周时的降幅显著大于即刻转换组(-0.44±0.03 vs.-0.06±0.03 mmol/L,P<0.001),两组LDL-C高风险分层百分比自基线到144周分别下降60.0%和78.1%。治疗144周时两组eGFR值分别为(109.1±20.4)mL/min/1.73 m^(2)与(106.3±13.9)mL/min/1.73 m^(2),组间差异无统计学意义(P>0.05)。结论EFV为核心的cART方案以及含TAF的整合酶抑制剂(INSTIs)方案转换为ANV/3TC/TDF均可实现持续病毒学抑制,同时持续改善LDL-C水平及ASCVD风险分层。由含TAF的INSTIs方案转换为ANV/3TC/TDF方案后,可显著降低LDL-C异常的研究对象比例。
文摘BACKGROUND Entecavir(ETV)and tenofovir fumarate(TDF)are recommended first-line agents for the treatment of chronic hepatitis B virus(HBV)infection.However,the effect of these 2 antiviral agents on the risk for recurrence of HBV-associated hepato-cellular carcinoma(HCC)after radical hepatectomy remains controversial.AIM To compare the effect of TDF vs ETV on the risk for HCC recurrence after radical surgery for HBV-related HCC.METHODS Data from consecutive patients,who received TDF or ETV after radical hepatec-tomy for HBV-related HCC and admitted to the Second Hospital of Longyan between December 2018 and December 2023,were retrospectively analyzed.Based on treatment method and propensity score matching(PSM),data from 100 patients were included,with 50 in each of the TDF and ETV groups,respectively.The baseline characteristics of the 2 groups were analyzed,and the risk for HCC recurrence was compared between the groups.RESULTS The median follow-up for 100 patients[median age,61 years;84 male(84%)]who underwent radical resection for HBV-related HCC-Barcelona Clinic Liver Cancer stage 0[n=16(16%)],stage A[n=61(61%)]-was 29 months(range,12-60 months);the median tumor size was 3.0 cm(range,2.1-4.3 cm).Sixty-eight(68%)patients exhibited HBV-DNA levels>1000 IU/mL.Twenty-two(22%)patients tested positive for hepatitis B e antigen,in whom the HCC recurrence rate was 59.1%(13/22).After PSM,HCC recurrence rates in the ETV and TDF groups after hepatectomy were 66%(n=33)and 42%(n=21),respectively(P=0.016),and cumulative recurrence rates at 1,3,and 5 years were 26%,58%,and 66%,and 18%,38%,and 42%,respectively(P=0.045).CONCLUSION TDF treatment is associated with a lower risk for HCC-related outcomes than that for ETV in patients with HBV-associated HCC after curative therapy.
基金Supported by the Japan Agency for Medical Research and Development(AMED),No.JP22fk0310503.
文摘BACKGROUND Tenofovir alafenamide fumarate(TAF)is one of the first-line treatments used to treat chronic hepatitis B patients;TAF has strong antiviral activity and a high barrier to resistance.Although virological breakthroughs in patients during TAF treatment are rare,patients with incomplete responses to TAF are occasionally observed.AIM To investigate responsible mutations in the reverse transcriptase region of hepatitis B virus(HBV)for TAF-incomplete responses.METHODS Thirteen chronic hepatitis B patients who received TAF monotherapy were included.A TAF-incomplete responder was defined as one who was continuously positive for HBV DNA over 2 years after TAF treatment initiation.The emergences of mutations in TAF-incomplete responders were evaluated before,one year after,and two years after treatment by deep sequencing of HBV DNA and RNA.RESULTS Two patients were continuously positive for HBV DNA over two years.The rtL269I mutation,one of the CYEI mutations linked to tenofovir resistance,was detected in both patients by direct sequencing.The deep sequencing analysis revealed that a combination of rtT118A and rtL220I mutations and the rtL269I mutation were predominantly detected in HBV DNA even when these mutations were barely detected in HBV RNA.This suggests a superior replication capability of the HBV variants with these mutations under TAF treatment.CONCLUSION The deep sequencing analysis of HBV DNA and RNA and comparing the detection rates of mutations were useful for estimating responsible mutations for TAF-incomplete responses.Such analysis is needed to evaluate the association between mutations that emerge during TAF treatment and incomplete responses to TAF.
