Relationship between nephrotoxicity and long-term adefovir dipivoxil therapy for chronic hepatitis B: A meta-analysis

Risk of Nephrotoxicity in Patients With Drug-Resistant Tuberculosis Treated With Kanamycin/Capreomycin With or Without Concomitant Use of Tenofovir-Containing Antiretroviral Therapy

BACKGROUND

The intersection of HIV and drug-resistant (DR) tuberculosis (TB) presents the challenge of managing convergent drug toxicities.

METHODS

We conducted a retrospective study of adult patients with DR-TB treated with a kanamycin/capreomycin-based (KM) regimen, with or without concomitant antiretroviral therapy (ART). We estimated the incidence of nephrotoxicity (defined as an increase in serum creatinine greater than 26.5 µmol, or an increase in serum creatinine to 1.5 times the baseline value, or a decline in glomerular filtration rate to less than 60 mL/min/1.73 m), and evaluated the association between reported drug use and nephrotoxicity using Kaplan-Meier plots.

RESULTS

A total of 215 patients with DR-TB were treated with a kanamycin/capreomycin-based regimen, with or without concomitant ART. The incidence rate of nephrotoxicity was 3.6 [95% confidence interval (CI): 1.4 to 7.3], 6.9 (95% CI: 5.2 to 9.0), and 12 (95% CI: 3.3 to 30.9) cases per 100 person-months of follow-up in the KM only group (n = 42), the KM + TDF (tenofovir disoproxil fumarate) group (n = 163), and the KM + Other ART group (n = 10), respectively. Using the KM only group as a reference, the hazard ratio was 2.06 (95% CI: 0.92 to 4.63) in the KM + TDF group, and 4.09 (95% CI: 1.17 to 14.25) in the KM + Other ART group. Advancing age was an independent predictor of nephrotoxicity (adjusted hazard ratio 1.29, 95% CI: 1.14 to 1.46).

CONCLUSIONS

Our findings provide evidence of a significant risk of nephrotoxicity during treatment with a kanamycin/capreomycin-based DR-TB regimen, with or without concurrent treatment with ART. This study lends further support to calls for the substitution of TDF during the intensive phase of DR-TB treatment and for close monitoring of renal function during DR-TB treatment, especially in settings where the use of kanamycin/capreomycin is unavoidable.

Effect of adding on telbivudine or switching to telbivudine alone on therapeutic efficacy and renal function in chronic hepatitis B patients on adefovir dipivoxil monotherapy

AIM

To explore the serum conversion rate of hepatitis B e antigen (HBeAg) and renal function in patients with chronic hepatitis B (CHB) treated with aldefovir dipivoxil (ADV) plus telbivudine (L-DT).

METHODS

This retrospective cohort study included 42 patients with HBeAg-negative CHB who were on ADV (10 mg) monotherapy. Twenty patients were treated with L-DT add-on therapy (combination therapy group), and 22 patients were switched to ETV monotherapy (monotherapy group). At 24 and 48 wk, the conversion rate of HBeAg and renal function evaluated by estimated glomerular filtration rate (eGFR) were analyzed and compared between the two groups.

RESULTS

The eGFR at 24 and 48 wk did not differ significantly between the two groups (P = 0.773, 0.108). The eGFR in the combination therapy group was significantly higher at 48 wk than at baseline (t = -6.184, P < 0.05), but no significant difference was observed in the monotherapy group (t = -0.893, P > 0.05). The serum conversion rates of HBeAg at 24 wk and 48 wk were significantly higher in the combination therapy group than in the monotherapy group (P = 0.043, 0.034).

CONCLUSION

L-DT based treatment is effective in elevating the serum conversion rate of HBeAg, and long-term therapy is associated with sustained improvement of renal function, particularly among HBeAg-negative CHB patients treated with ADV.

Kushenin combined with adefovir dipivoxil affects the HBV-DNA load in serum, immune functions and liver functions of patients with chronic hepatitis B

This study aimed to explore the effect of kushenin combined with adefovir dipivoxil on the load of hepatitis B virus DNA (HBV-DNA) in serum, in immune functions and in liver functions of patients with chronic hepatitis B. A sample of 80 patients with chronic hepatitis B was selected who were admitted to Weifang People's Hospital for treatment between January, 2013 and December, 2015. They were divided into the observation group (n=40) and the control group (n=40). The patients in both groups received adefovir dipivoxil, while those in the observation group additionally received the kushenin. Variations in HBV-DNA load and transforming growth factor-β1 (TGF-β1) in the two groups were detected before intervention, at 1 month, 3 months and 6 months after intervention. In addition, after intervention, we also observed the changes in CD4+, CD8+ and CD4+/CD8+, as well as the levels of immune globulin. Furthermore, in these two groups, we detected the changes in endotoxin in serum before and after intervention, the liver function after intervention, and the variations of hyaluronic acid (HA) and type III procollagen (PCIII) before and after intervention which were used to serve as the indicators for hepatic fibrosis. Results showed that at one month, 3 months and 6 months after intervention, HBV-DNA load and the level of TGF-β1 in the observation group were lower than those in the control group (P<0.05). In the observation group, the HBV-DNA load at 6 months after intervention was the lowest, sequentially followed by the levels at 3 months, at 1 month and before intervention (P<0.05). After intervention, the levels of CD4+ and CD8+ and CD4+/CD8+ in the observation group were higher than those in the control group (P<0.05). Moreover, the levels of immunoglobulin M (IgM), immunoglobulin G (IgG) and immunoglobulin A (IgA) were elevated in the observation group compared to the levels in the control group (P<0.05). Additionally, the level of endotoxin in serum, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil). Besides, after intervention, the levels of HA and PCIII in the observation group were found to be lower than those in the control group before and after intervention (P<0.05). This study concludes that, for patients with chronic hepatitis B, kushenin combined with adefovir dipivoxil can remarkably decrease the HBV-DNA load, improve their immunity, ameliorate the liver function and delay the onset of liver cirrhosis.

Reversal of Proximal Renal Tubular Dysfunction after Nucleotide Analogue Withdrawal in Chronic Hepatitis B

Aims

Proximal renal tubular dysfunction (PRTD) is an infrequent complication after nucleotide analogue therapy. We evaluated the outcomes of PRTD and nephrotoxicity after nucleotide analogue withdrawal in chronic hepatitis B (CHB).

Methods

A longitudinal follow-up study was performed in patients with PRTD after nucleotide analogue discontinuation. Serum and urine were collected at baseline and every 3 months for one year. The fractional excretion of phosphate (PO₄), uric acid (UA), and potassium and tubular maximal reabsorption rate of PO₄ to glomerular filtration rate (TmPO₄/GFR) were calculated. Renal losses were defined based on the criteria of substance losses. Subclinical PRTD and overt PRTD were diagnosed when 2 and ≥3 criteria were identified.

Results

Eight subclinical and eight overt PRTD patients were enrolled. After nucleotide analogue withdrawal, there were overall improvements in GFR, serum PO₄, and UA. Renal loss of PO₄, UA, protein, and β2-microglobulin reduced over time. At one year, complete reversal of PRTD was seen in 13 patients (81.2%). Improvements in PRTD were seen in all but one patient.

Conclusion

One year after nucleotide analogue withdrawal, PRTD was resolved in most patients. Changes in TmPO₄/GFR, urinary protein, and β2-microglobulin indicate that urinary biomarkers may represent an early sign of PRTD recovery.