Several misunderstandings about tenofovir
First, the strongest tenofovir efficacy, hoping to be discontinued earlier
From clinical experience, tenofovir may be more potent than entecavir. Approximately 10% of patients in entecavir have a poor response. After 1 year of treatment, the virus is not degraded anymore for the third power of the virus, and the virus is switched to negative for 3 months in the meantime. Ten-year effects of tenofovir treatment are rare. Tenofovir reduces the likelihood of being faster than entecavir.
However, the commonality of all nucleoside drugs can only remove the active replication of the virus, the virus antigen has no direct effect, in the "full three positive" patients, E antigen negative most of the time also 4,5 years, Sometimes a small amount of residual E antigen may lag 1,2 years or even longer.
Possibly, the potency of tenofovir rapidly reduces the level of viral replication and significantly reduces the replenishment of the virus matrix, perhaps leading to inactive delivery that still requires medication. My outpatient women who took 3 years, the surface antigen negative, the surface antibody over 1000 mIU / ml, did not rebound after stopping, but this is only one of thousands of patients.
Second, tenofovir nephrotoxicity need to observe the serum renal function
Tenofovir is currently used in some HIV instructions in English, severe adverse reactions, including tubular damage, when the glomerular filtrate of calcium, phosphorus can not be reabsorbed back to the blood, causing Rhesus (I have such a disease of cartilage Seen a long-term use of adefovir in field patients, the short term has been difficult to reverse). We examined urinary β2-microglobulin 24 hours a year in patients who took tenofovir, a slight increase in middle-aged and older people over 45 years of age in 2 years, but not in young adults, but may be used for long-term Happen, so regular inspection is essential.
In patients with mild renal insufficiency, according to endogenous creatinine clearance rate of 60 to 90% tenofovir dose per 36 hours a tablet, << 60% ~ 30% half a tablet daily. Check every 24 months urinary β2 microglobulin 24 hours, if the protein increased for 3 months to review the majority of entecavir can be normal, can be replaced by tenofovir.
Third, long-term use of drug resistance can be cured
Tenofovir approved in 2008 for chronic hepatitis B, has not been confirmed in nearly 8 years of resistance, has been tested in HIV and hepatitis B virus-infected patients suspected of drug-resistant strains were eventually studied in detail and negative. To date, no clinical and clinical evidence of response to treatment-effective patients has been found, and cases of resistance have been identified. Therefore, it is not known where the site of resistance to tenofovir is.
I was infected with hepatitis B virus in two stem cells and took tenofovir by weight in children with high doses of immunosuppressants such as corticosteroids. One of the patients observed negative control of the virus for more than six months so far.
Chronic hepatitis B virus infection in our country accounts for half of such patients in the world. The drug is widely used after its price reduction. It is also possible that some drug resistance will occur after many years. However, there is no need to worry about the current situation, fear of its resistance, and then no cure. Shanghai scientific experts have found a new drug similar to interferon therapeutic mechanism, code-named AZ4, in vitro experiments can be anti-hepatitis B virus, research papers have been published in international journals, very successful prospects. At present, China's overall scientific research level is second only to the United States, and we should have confidence.
Fourth, pregnant women with hepatitis consider tenofovir on the safety of the fetus
80% of our tenofovir is used in pregnant women with chronic hepatitis B, nearly a thousand newborns, and no feedback on health problems. There are still some limitations. In fact, the international community has long been widely used and no newborn deformities exceeding the normal probability have been reported.
There are still chronic hepatitis B pregnant women worry about this drug unsafe, elevated aminotransferases are not anti-viral treatment, and some succumb to the opposition of her mother, hepatitis mom want to reproduce healthy baby is not some hanging.
Tell a story: A woman from Daqing a few years ago, half the size of the liver of the congenital malformations and unfortunately suffered from hepatitis B cirrhosis, her husband worked very hard in foreign enterprises, she regardless of their risk requirements for her husband to have a baby. Renting near the hospital, serving tenofovir and a small number of auxiliary drugs, six months after the main indicators of normal return to medicine. Before labor, I went to our hospital and asked for labor protection. At this time, I took Tenofovir after I had been pregnant. She mistakenly believed that she was the safest to take her fetus and would rather take the risk himself. After checking the virus and liver function has rebounded, bleeding occurred during childbirth, the rescue and recovery, and stay in Guangzhou to observe, did not happen after delivery of acute liver failure back.
Fifth, with tenofovir, do not have to entecavir and interferon (or Pegasus)
Tenofovir, entecavir and piroxicam are top-line anti-hepatitis B drugs with different strengths and weaknesses and should be selected on a case-by-case basis or on your own.
Patients with a near relative of malignancy, especially mild cirrhosis, are best "big three positive" (or surface antigens less than 1000 iu / ml), and patients treated with piroxicam are almost free from HCC.
Entecavir adverse reactions, as long as no alcohol, no immunosuppressive drugs and norms of medication, but also rarely resistant. Clinical application of my clinic for nearly 10 years, resistant to 7,8 people, except 1, are "out of cause."
Entecavir is the best bupropion for tenofovir when kidney damage occurs in tenofovir or individual patients (for some time) are intolerant and can be temporarily switched to entecavir for several months. Even if there was lamivudine resistance, but also to protect the entecavir own drug-resistant sites do not mutate.
The most prominent advantage of tenofovir is the strongest antiviral efficacy, derived from replication virus clearance many beneficial benefits of the disease.