Enfuvirtide: A safe and effective antiretroviral agent for human immunodeficiency virus–infected patients shortly after liver transplantation
Enfuvirtide: A safe and effective antiretroviral agent for human immunodeficiency virus–infected patients shortly after liver transplantation
复制标题
恩夫韦肽：一种安全有效的抗逆转录病毒药物，适用于肝移植后不久感染人类免疫缺陷病毒的患者
作者：
E. Teicher;C. Abbara;J. Duclos‐Vallée;T. Antonini;L. Bonhomme‐Faivre;D. Desbois;D. Samuel;D. Vittecoq
本研究的目的是评价与基于洛匹那韦/利托那韦的抗逆转录病毒（ARV）方案相比，基于恩夫韦肽的抗逆转录病毒（ARV）方案对丙型肝炎病毒（HCV）/乙型肝炎B病毒（HBV）/人类免疫缺陷病毒（HIV）合并感染肝移植患者的免疫抑制管理和随访的影响。他克莫司和环孢素谷浓度在3个阶段内测定：肝移植后未接受ARV治疗（第1阶段）、重新引入ARV时（第2阶段）和肝移植后2 - 3个月（第3阶段）。比较了22例HIV合并感染患者的结果（18例HCV和4例HBV）; 11例患者接受恩夫韦肽治疗，并与11例暴露于洛匹那韦/利托那韦的患者相匹配。在第1阶段，他克莫司和环孢素A剂量分别为8和600 mg/天，两组的谷浓度均在治疗范围内。在第2阶段，在免疫抑制剂方案中添加洛匹那韦/利托那韦，可以降低维持谷浓度在治疗范围内所需的免疫抑制剂剂量（他克莫司为0.3 mg/天，环孢素为75 mg/天）。免疫抑制剂剂量未因重新引入恩夫韦肽而改变，3个阶段的平均谷浓度无变化。CD 4细胞计数保持在约200个细胞/mm。HIV RNA病毒载量仍然无法检测到。两组均显示由于HCV复发而导致的轻度细胞溶解和胆汁淤积体征，而未观察到肾功能不全。恩夫韦肽是标准抗逆转录病毒治疗的一种有吸引力的替代方案，有助于肝移植后不久的药物相互作用的管理。此外，缺乏肝毒性使得这种药物在严重HCV复发的情况下很有价值。肝移植15：1330-1335，2009。© 2009 AASLD。
The aim of this study was to evaluate the impact of an enfuvirtide‐based antiretroviral (ARV) regimen on the management of immunosuppression and follow‐up in hepatitis C virus (HCV)/hepatitis B virus (HBV)/human immunodeficiency virus (HIV)–coinfected liver transplant patients in comparison with a lopinavir/ritonavir‐based ARV regimen. Tacrolimus and cyclosporine trough concentrations were determined at a steady state during 3 periods: after liver transplantation without ARV treatment (period 1), at the time of ARV reintroduction (period 2), and 2 to 3 months after liver transplantation (period 3). The findings for 22 HIV‐coinfected patients were compared (18 with HCV and 4 with HBV); 11 patients were treated with enfuvirtide and were matched with 11 lopinavir/ritonavir–exposed patients. During period 1, tacrolimus and cyclosporine A doses were 8 and 600 mg/day, respectively, and the trough concentrations were within the therapeutic range in both groups. In period 2, the addition of lopinavir/ritonavir to the immunosuppressant regimen enabled a reduction in the dose of immunosuppressants required to maintain trough concentrations within the therapeutic range (to 0.3 mg/day for tacrolimus and 75 mg/day for cyclosporine). Immunosuppressant doses were not modified by the reintroduction of enfuvirtide, there being no change in the mean trough concentrations over the 3 periods. CD4 cell counts remained at about 200 cells/mm. The HIV RNA viral load remained undetectable. Both groups displayed signs of mild cytolysis and cholestasis due to the recurrence of HCV, whereas no renal insufficiency was observed. Enfuvirtide is an attractive alternative to standard ARV therapy, facilitating the management of drug‐drug interactions shortly after liver transplantation. Moreover, the lack of liver toxicity renders this drug valuable in the event of a severe HCV recurrence. Liver Transpl 15:1330–1335, 2009. © 2009 AASLD.
影响因子：
10.8
作者：
Benet, LZ;Izumi, T;Wacher, VJ
通讯作者：
Wacher, VJ