Tenofovir disoproxil fumarate (TDF) is a recommended first-line therapy for both naïve and experienced patients with chronic hepatitis B (CHB), although reduced estimated glomerular filtration rate (eGFR), hypophosphatemia, hyperphosphaturia and Fanconi syndrome have been reported in some patients. Entecavir (ETV) could be considered as a rescue therapy for TDF-treated patients developing renal dysfunction, though patients with prior history of treatment with lamivudine (LAM) can develop ETV resistance strains, which can lead to potentially severe hepatitis flares. Tenofovir alafenamide (TAF), a new prodrug of tenofovir, has recently been developed to improve the renal and bone safety profile compared to TDF, while maintaining the same virologic efficacy. The recently published 48-week phase III TAF registration studies confirmed the superior safety profile. Here we describe a case of a 75-year-old woman with HBV mono-infection and compensated cirrhosis who developed ETV resistant strains and grade 3 chronic kidney disease after many years of LAM and adefovir (ADV) treatment and a TDF-induced Fanconi syndrome. The administration of 25mg/day of TAF, granted as part of a compassionate use program, rapidly suppressed viral replication to undetectable levels without worsening renal function or side effects.

中文翻译：

---

替诺福韦艾拉酚胺作为具有范可尼综合征史和多药耐药性的肝硬化乙型肝炎患者的挽救治疗：病例报告


富马酸替诺福韦二吡呋酯 (TDF) 是慢性乙型肝炎 (CHB) 初治和有经验患者的推荐一线治疗方法，尽管一些患者报告了估计肾小球滤过率 (eGFR) 降低、低磷血症、高磷酸盐尿症和范可尼综合征。恩替卡韦 (ETV) 可被视为对 TDF 治疗后出现肾功能障碍的患者的挽救疗法，尽管既往接受过拉米夫定 (LAM) 治疗史的患者可能会出现 ETV 耐药菌株，从而可能导致潜在的严重肝炎发作。替诺福韦艾拉酚胺 (TAF) 是替诺福韦的一种新前药，最近被开发出来，与 TDF 相比，可改善肾脏和骨骼安全性，同时保持相同的病毒学疗效。最近发表的为期 48 周的 III 期 TAF 注册研究证实了其卓越的安全性。在这里，我们描述了一名 75 岁女性，患有 HBV 单一感染和代偿性肝硬化，在经过多年 LAM 和阿德福韦 (ADV) 治疗以及 TDF 诱发的范可尼综合征后，她出现了 ETV 耐药菌株和 3 级慢性肾脏病。作为同情使用计划的一部分，每天服用 25 毫克 TAF 可以迅速将病毒复制抑制到不可检测的水平，而不会恶化肾功能或产生副作用。