Monsall Unit, Department of Infectious Diseases, North Manchester General Hospital, Manchester, UK.
HIV Med. 2009 May;10(5):269-73. doi: 10.1111/j.1468-1293.2008.00683.x. Epub 2009 Feb 5.
Tenofovir disoproxil fumarate (TDF) is active against hepatitis B virus (HBV) and HIV. However, the long-term efficacy of tenofovir disoproxil fumarate (TDF) is not well known and the appearance of resistance is a major concern. We have studied the efficacy of TDF against HBV in patients treated at an Infectious Diseases Unit.
We carried out a retrospective observational study of the efficacy of TDF against HBV replication in a cohort of 52 HIV-coinfected patients who received TDF for at least 6 months.
The median duration of follow-up of TDF treatment was 34 months. Forty-one patients (79%) were positive for HBV envelope antigen (HBeAg) and 35 had received previous lamivudine monotherapy for a median duration of 32 months. Virological breakthrough was observed in nine cases (17%). At the end of the follow-up period, HBV DNA levels were <1000 copies/mL in 42 patients (81%) and <200 copies/mL in 31 patients (60%). There were no significant differences between the lamivudine-naïve and lamivudine-experienced groups. In the lamivudine-experienced group, the duration of previous lamivudine monotherapy was associated with failure to achieve HBV DNA levels <200 copies/mL (P=0.036). Adding lamivudine or emtricitabine to TDF did not improve virological suppression. In 39 patients who achieved <200 HBV DNA copies/mL during TDF treatment, virological breakthrough was seen only in two patients (5%) after a median follow-up duration of 39.7 months.
TDF was able to control HBV replication in most HIV-coinfected patients after a median follow-up duration of 34 months, regardless of previous lamivudine treatment. However, a sizeable proportion of patients developed virological breakthrough.
富马酸替诺福韦二吡呋酯（TDF）对乙型肝炎病毒（HBV）和 HIV 均具有活性。然而，TDF 的长期疗效尚不清楚，耐药性的出现是一个主要关注点。我们研究了 TDF 在传染病科治疗的 HIV 合并感染患者中对 HBV 的疗效。
我们对至少接受 6 个月 TDF 治疗的 52 例 HIV 合并感染患者的 HBV 复制的 TDF 疗效进行了回顾性观察性研究。
TDF 治疗的中位随访时间为 34 个月。41 例患者（79%）HBV 包膜抗原（HBeAg）阳性，35 例患者之前接受过拉米夫定单药治疗，中位持续时间为 32 个月。9 例（17%）出现病毒学突破。随访期末，42 例患者（81%）HBV DNA 水平<1000 拷贝/ml，31 例患者（60%）HBV DNA 水平<200 拷贝/ml。拉米夫定初治组和拉米夫定经治组之间无显著差异。在拉米夫定经治组中，之前拉米夫定单药治疗的持续时间与未能达到 HBV DNA 水平<200 拷贝/ml 相关（P=0.036）。在 TDF 治疗中添加拉米夫定或恩曲他滨并不能改善病毒学抑制。在 39 例达到 TDF 治疗期间 HBV DNA<200 拷贝/ml 的患者中，仅在中位随访 39.7 个月后有 2 例患者（5%）出现病毒学突破。
在中位随访 34 个月后，TDF 能够控制大多数 HIV 合并感染患者的 HBV 复制，无论之前是否接受过拉米夫定治疗。然而，相当一部分患者出现了病毒学突破。
