替诺福韦酯初始治疗应答不佳的相关因素分析:病例报道及文献复习

Relevant factors for poor response to initial treatment with Tenofovir disoproxil fumarate: one case report and literature review

替诺福韦酯(TDF)是治疗慢性乙型肝炎(chronic hepatitis B, CHB)的一线核苷类似物。目前国内暂未出现TDF耐药案例。本文介绍1例40岁的HBeAg阴性CHB男性患者接受TDF 300 mg/d治疗,初始HBV定量基线水平较低,在治疗后6个月无法检测。然而,在TDF治疗12个月后出现反弹。我们试图找到与病毒学突破相关的突变位点,最终双中心耐药基因分析结果显示未找到突变位点。本文在最后也对患者TDF应答不佳的情况进行确认,并对造成TDF应答不佳的几种因素进行分析,以供业界参考。

Tenofovir disoproxil fumarate (TDF) is a potent nucleotide analogue that is recommended as first line therapy for patients with chronic hepatitis B (CHB). The results of a longitudinal study of TDF treatment demonstrated no development of resistance. One treatment-naive CHB patient who developed TDF suboptimal response after complete viral suppression was rebounded after 12 months TDF treatment. A 40 year old HBeAg negative man patient received TDF 300 mg/d for 12 months. The hepatitis B virus (HBV) DNA titer was low level at baseline and became undetectable at 6 months after treatment.However, the HBV DNA titer rebounded at 12 months after treatment. We tried to find mutation sites associated with virologic breakthrough. The results showed no mutation sites. Affecting factors of Tenofovir suboptimal response was also analyzed.