抗病毒药物替诺福韦可能引起的肾毒性：新的适应证、新的剂型和新的前药。
Potential kidney toxicity from the antiviral drug tenofovir: new indications, new formulations, and a new prodrug.
机构信息
Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Infectious Diseases, Department of Medicine, University of Alabama Birmingham, Birmingham, Alabama, USA.
出版信息
Curr Opin Nephrol Hypertens. 2018 Mar;27(2):102-112. doi: 10.1097/MNH.0000000000000392.
PURPOSE OF REVIEW
The antiviral agent tenofovir is highly effective for the treatment of HIV and hepatitis B virus infections, and the older prodrug tenofovir disoproxil fumarate (TDF) is also a component of daily preexposure prophylaxis (PrEP) to reduce the risk of HIV infection in high-risk populations. Although TDF is well tolerated, the potential for kidney and bone toxicity has important implications for public health given the large number of individuals exposed to TDF worldwide. This review summarizes the recent literature on kidney and bone health in individuals treated with TDF and the newer prodrug tenofovir alafenamide (TAF).
RECENT FINDINGS
Risk factors for TDF toxicity appear to be similar in patients treated for HIV or hepatitis B virus and in HIV-uninfected PrEP users, although drug-drug interactions are a more important concern in HIV-positive individuals. The risk of toxicity appears to be lower with TAF, but further studies are needed to confirm the safety of long-term use and to evaluate the efficacy of TAF-based PrEP.
SUMMARY
Nephrologists should be aware of the potential kidney and bone toxicity of TDF, as well as unique situations in which the newer prodrug TAF may contribute to kidney injury.
目的综述：抗病毒药物替诺福韦对于治疗 HIV 和乙型肝炎病毒感染非常有效，其前药富马酸替诺福韦二吡呋酯（TDF）也是每日暴露前预防（PrEP）的组成部分之一，可降低高危人群感染 HIV 的风险。虽然 TDF 具有良好的耐受性，但鉴于全球范围内有大量个体暴露于 TDF，其潜在的肾毒性和骨毒性对公共卫生具有重要意义。这篇综述总结了近期关于 TDF 治疗个体的肾脏和骨骼健康以及新型前药替诺福韦艾拉酚胺（TAF）的文献。
最新发现：TDF 毒性的危险因素在治疗 HIV 或乙型肝炎病毒的患者以及 HIV 未感染的 PrEP 使用者中似乎相似，尽管药物相互作用在 HIV 阳性个体中更为重要。TAF 的毒性风险似乎较低，但仍需要进一步的研究来证实长期使用的安全性，并评估 TAF 为基础的 PrEP 的疗效。
总结：肾脏病医生应该意识到 TDF 的潜在肾毒性和骨毒性，以及新型前药 TAF 在哪些特殊情况下可能导致肾脏损伤。
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