Liver Unit, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy.
Medicine Unit, Ospedale Maggiore di Lodi, Lodi, Italy.
J Clin Virol. 2014 Dec;61(4):600-3. doi: 10.1016/j.jcv.2014.09.016. Epub 2014 Oct 5.
Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor widely used to treat patients with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection. Despite the excellent safety records of this regimen, a few cases of acute renal failure and Fanconi syndrome have been reported among HIV patients exposed to TDF. In the HBV monoinfection scenario, only two cases of TDF-associated Fanconi syndrome have been reported thus far. Here, we describe two additional patients with chronic hepatitis B (CHB) who developed a TDF-induced Fanconi syndrome that reverted after TDF withdrawal and had viral replication fully suppressed upon switching to entecavir (ETV). Though the overall risk of TDF associated severe renal toxicity in HBV patients appears to be negligible, both glomerular and tubular function should be monitored in patients exposed to TDF, especially when other renal risk factors or a history of previous exposure to adefovir dipivoxil (ADV) are present.
富马酸替诺福韦二吡呋酯（TDF）是一种核苷酸逆转录酶抑制剂，广泛用于治疗人类免疫缺陷病毒（HIV）和乙型肝炎病毒（HBV）感染患者。尽管该方案具有出色的安全性记录，但在接触 TDF 的 HIV 患者中，仍有少数急性肾衰竭和范可尼综合征的病例报告。在 HBV 单感染情况下，迄今为止仅报告了两例与 TDF 相关的范可尼综合征。在这里，我们描述了另外两名患有慢性乙型肝炎（CHB）的患者，他们发生了 TDF 诱导的范可尼综合征，在停用 TDF 后恢复，并且在改用恩替卡韦（ETV）后病毒复制完全受到抑制。尽管 TDF 相关严重肾毒性在 HBV 患者中的总体风险似乎可以忽略不计，但应监测接触 TDF 的患者的肾小球和肾小管功能，特别是当存在其他肾脏危险因素或先前接触阿德福韦酯（ADV）的病史时。
