The advantages and disadvantages of the most complete tenofovir

- Dec 21, 2017 -

The advantages and disadvantages of the most complete tenofovir

Tenofovir

First, the strongest tenofovir efficacy, removal of replication virus fastest.

Approximately 10% of patients in entecavir have a poor response. After 1 year of treatment, they usually no longer reduce the iu / ml of the virus by the third reagent, and switch to the 3-month metropolitan virus of tenofovir for negative conversion. Ten-year effects of tenofovir treatment are rare.

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Big three positive

Small three positive


HBV DNA negative rate / HBeAg conversion rate

HBV DNA negative rate

Tenofovir treatment for 48 weeks

76%/21%

93%

Entecavir treatment for 48 weeks

67%/21%

90%

Tenofovir for 8 years

98%/31%

99.60%

The disappearance rate of HBsAg was 13 % after 8 years of tenofovir treatment

Tenofovir Efficacy and compared with entecavir

Second, the most reliable reversal of liver fibrosis

A total of 348 liver biopsy samples were obtained before treatment, 1 year and 5 years, of which 96 were liver cirrhosis (fibrosis score 5-6 points), with a reduction of at least 2 points except 1 and a decrease of 3 points in 56 cases. Most of the patients had reversal of liver cirrhosis . After tenofovir treatment of liver cirrhosis reversal, fibrosis significantly reduced, but to restore very fine hepatic lobule structure may not be easy.

Third, women's birth breast-feeding on the fetus the safest.

Tenofovir is safe to the fetus, does not cause deformity, is also non-toxic;

Tenofovir potent anti-virus to pregnant women, will not be resistant to the delivery of almost all of the virus can turn negative, can naturally block mother-to-child transmission;

Tenofovir is recommended as a block for mother-to-child HIV / AIDS, although less safety data are available for pregnant women with hepatitis B;

Pregnancy Grade B drugs, which are rarely excreted through breast milk, are unlikely to cause significant toxicity, but there is an unknown risk of exposure to low levels of drug in infants and mothers should be aware that they weigh the pros and cons;

Fourth, not resistant

5-year resistance rate of entecavir 1.2%; tenofovir 8-year no resistance, the virus will not rebound after the negative. Its resistance site, A194T, occurred in two HIV-infected patients with hepatitis B. Only in patients with adefovir dipivoxil for tenofovir, A181T and N236V were detected, which is the adefovir-resistant locus.

Fifth, wide adaptability

Whether it is lamivudine resistance, adefovir resistance, resistance to entecavir, adefovir poor response, lamivudine and adefovir combined resistance, tenofovir showed The higher the virological response, and well tolerated.

Six, less security

Individuals with elevated aminotransferases, dizziness, rash, increased creatine kinase, but the probability of occurrence is very low, there is no need for long-term withdrawal of patients, creatine kinase increased, but did not occur myositis.

Adverse reactions to adefovir and tenotin were mainly tubular damage, and their toxicity was related to the dose of the drug. The main function of tubules is reabsorption, tenofovir can reduce renal tubular reabsorption of phosphorus, calcium, potassium, uric acid, glucose and small molecules of protein and other substances. Reduce the phosphorus can cause osteoporosis, osteomalacia. Although the incidence is not high, the incidence of elevated serum creatinine after 5 years of treatment is about 0.5% -2.8%, and the incidence of hypophosphatemia is more than 4%. However, during the treatment of tenofovir, serum creatinine and serum phosphorus should be regularly tested, adverse reactions should be detected, and the dosage of drugs or phosphorus supplementation should be given timely.

Seven, what kind of crowd can not use blindly

Should not be treated hepatitis B virus infection Do not blindly use tenofovir treatment. In foreign clinical studies, after 8 years of tenofovir dipivoxil treatment, HBeAg-positive patients with HBV DNA below the detection limit

Patients who are being treated with other nucleoside (acid) drugs and who respond well do not have to switch to Tenofovir for recovery. Tenofovir is not a prodigy. Like other nucleosides (acids), tenofovir can only achieve long-term suppression of virus replication and can not completely eradicate hepatitis B virus in a short period of time. Therefore, clinical trials abroad will come to the above-mentioned 8-year research results. Moreover, in the short term there will be no new anti-hepatitis B drugs listed. If the current treatment is effective, it may be better to maintain the current treatment and leave Tenofovir as an alternative drug in the future, with options available if needed.

Previous use of adefovir renal damage in patients with cautious tenofovir treatment. Adefovir and tenofovir belong to the same class, all of which have the potential to cause kidney damage and reduced serum phosphate levels, and the same mechanism of nephrotoxicity. Although tenofovir is more pre-existing in kidney damage than adefovir, renal failure has been associated with renofovir in patients who had previously had renal damage during adefovir treatment. Unless last resort, do not choose tenofovir treatment. Patients who must be treated with tenofovir should be given an adjusted dose of tenofovir based on their renal function and creatinine clearance under the guidance of an experienced doctor and used with caution by their doctor.

Eight, use should pay attention to what?

What is the treatment dose of tenofovir? When the best medicine every day?

Adult tenofovir dipivoxil dose of 300 mg once daily. Under normal circumstances patients can not consider the impact of diet on medication, fasting or postprandial medication can be. Patients with poor efficacy can be taken after high-fat meal to improve drug bioavailability and plasma concentration. However, patients with kidney damage should not be taken with high-fat meals, so as not to increase blood concentration, so that increased renal damage.

Which drugs have an interaction with tenofovir and can not be taken together?

Tenofovir and adefovir belong to the same class of drugs and have the same nephrotoxicity. These two drugs, taken together, can affect the clearance and excretion of drugs in the kidneys and increase the risk of kidney damage and therefore can not be combined.

Tenofovir interacted with retipavirt, a drug used to treat hepatitis C, and retivapas increased the plasma concentration of tenofovir, resulting in increased nephrotoxicity of tenofovir.

Tenofovir disoproxil interacts with some HIV-themed drugs (eg, didanosine), taking at the same time the risk of adverse reactions that may increase with each other. Medication should be administered under the guidance of a physician and monitored.

Patients before using tenofovir treatment of renal function, electrolytes (potassium, sodium, calcium, phosphorus), urine and other tests, as the basis for the subsequent observation of adverse reactions. Patients with pre-treatment renal impairment, pre-treatment with significant hypophosphatemia, hypokalemia and hypocalcemia in patients with caution tenofovir treatment.