Background: TENOFOVIR is among the first-line treatments for chronic hepatitis B (CHB) virus infection. We evaluated the efficacy of TENOFOVIR in the treatment of Iranian adult patients with CHB. Methods: In a retrospective study, we evaluated 154 HBsAg positive patients referred to Sadoughi hospital in Yazd-Iran for treatment during 2009-2014. Forty-five patients were naive and 109 patients were treated previously with lamivudine or interferon. HBs Ag, HBeAg, HBeAb and quantitative HBV-DNA PCR were measured. The patients with HBV DNA >10, 000 copy per ml in precore mutant and HBV DNA>100, 000 copy per ml in wild type and ALT >two times of normal value were included. TENOFOVIR disoproxil fumarate 300 mg was administered and continued for three years. Data were analyzed using SPSS19. Results: We enrolled 154 (109 males 45 female) patients. Mean age of patients was 41± 8 years (18-58 year old). Forty-five of them were naive and the rest had previously experienced treatment. In this study, 113 of patients were of wild type and 41 patients were precore mutant variant. In wild type patients, 25 ones were naive and in precore mutant subtype, 20 patients were naive. HBsAg disappeared in 5 patients (3. 2 percent). Forty one of 45 patients in the naive group (91 percent) and 96 of 109 patients in the previously treated group (88 percent) were cured. AST and ALT levels decreased in over 80 percent of patients and means of AST and ALT levels showed more decrease in naive and precore mutant subgroups. Serum AST and ALT and HBV DNA were higher in the wild type group than in the precore mutant group. Seroconversion occurred in 69 out of 113 patients at the end of the study. Conclusion: Treatment response rate to TENOFOVIR in Iranian patients with CHB was high. TENOFOVIR could be recommended as the first-line therapy of chronic HBV infection in Iran.

Background: In chronic hepatitis B patients with or exposed to the risk of osteoporosis or renal dysfunction, switching from TENOFOVIR disoproxil fumarate (TDF) to TENOFOVIR alafenamide fumarate (TAF) or entecavir (ETV) may be the right choice. Objectives: This study aimed to present real-life data in terms of the efficacy and safety of a TAF/ETV treatment change while receiving TDF. Methods: This retrospective study was conducted on 344 adult patients from 10 centers. The data of patients who had changed to ETV (n = 107) and TAF (n = 237) while receiving TDF were analyzed. The data collected at 0 and 6 months of treatment were analyzed. The virological response was assessed based on undetected hepatitis B virus (HBV) DNA. Serum alanine aminotransferase (ALT) values were used to evaluate the biochemical response. For renal function, serum creatinine and phosphorus, as well as estimated glomerular filtration rate (eGFR), were recorded. Moreover, lumbar spine and hip T-scores along with the serum lipid profile were evaluated. Results: The mean age of patients was 41. 14 ,13. 46 years, and 224 (65. 1%) of the participants were male. The treatment arms were not significantly different in terms of demographic characteristics, comorbid diseases, infection duration, family history of HBV infection, blood platelet count, serum biomarkers, such as ALT, phosphorus, creatinine, total bilirubin, albumin, lipid profile, and HBV DNA levels at the beginning. No statistically significant difference was found between the proportion of undetectable HBV DNA of thetwotreatment groups after6months(P=0. 221). The ALT normalization in the ETVandTAF groups at the sixthmonthcompared to the baseline levels was not significantly different (P = 0. 853, P = 0. 330, respectively). There wasnostatistically significant difference between the two treatment arms regarding changes in eGFR, creatinine, phosphorus, hip, and spine T-scores from baseline to 6 months (P = 0. 296, P = 0. 78, P = 0. 141, P = 0. 832, P = 0. 947, respectively). In those who switched to TAF or ETV, low-density lipoproteins cholesterol were observed to be significantly higher after 6 months compared to baseline values (P = 0. 002, P = 0. 049, respectively). The TC increased significantly in the TAF group (P = 0. 035). Conclusions: Our study showed that switching to ETV and TAF sustained the viral suppression and biochemical response achieved by TDF therapy. The treatment switch to TAF of ETV can control renal dysfunction and reduce bone mineral density caused by TDF.

Background: Chronic hepatitis B (CHB) is a viral infection that can result in life-threatening conditions, such as hepatocellular carcinoma and cirrhosis. TENOFOVIR, which is used for the treatment of CHB, is a nucleotide analog that inhibits HBV-DNA polymerase and has two formulations: disoproxil and alafenamide. In contrast to TENOFOVIR disoproxil fumarate (TDF), TENOFOVIR alafenamide fumarate (TAF) penetrates the whole hepatocyte without being eliminated due to its longer plasma half-life and greater plasma stability. As a result, side effects such as proximal renal tubulopathy and loss of bone density are less common in the treatment of TAF and have similar efficacy to TDF. Objectives: The purpose of the study was to evaluate the effectiveness and reliability of TAF using real-life data. Methods: This retrospective cohort study was carried out in secondary or tertiary healthcare centers in southern Turkey. A total of 480 patients aged 18 years and older were administered TAF for an appropriate indication by the infectious diseases and gastroenterology clinics of the healthcare centers participating in this study. The data collected at t = 0, t = 3, and t = 6 months of treatment were analyzed. The chi-square, Mann-Whitney U, Friedman, Wilcoxon, Cochran’ s Q, and McNemar’ s tests were used. Results: The mean age of the patients was 47. 40 14. 5, and 327 of them (68. 1%) were male. A total of 78. 1% of the 480 patients who underwent the TAF treatment had previous antiviral therapy experience (TDF, n = 340; 70. 8 %), and 21. 9% were treatment-naive. The most common reasons for the initiation of TAF treatment were the use of drugs affecting bone mineral density (BMD) (42. 9%) and osteoporosis (22. 3%). Patients who had taken TDF experienced a significant improvement in glomerular filtration rate (GFR), hip and spine T-scores, and phosphorus levels from t = 0 months to t = 6 months after switching to TAF (P < 0. 05). For this group, no statistically significant difference was observed concerning LDL and cholesterol levels from t = 0 months to t = 6 months. Side effects were reported by 5. 7% of patients in the third month and 7. 1% in the sixth month, with the most common side effect being hair loss (1%). Conclusions: TAF was found to be an effective and safe alternative to TDF with lower incidences of its long-term effects, such as nephrotoxicity and decreased bone density.

Antiretroviral drugs have improved the course of human immunodeficiency virus (HIV) infection.The cornerstone of these treatments is selection of potent and tolerable regimens to which the patient can adhere and suppress the HIV replication without side effects and emergence of drug resistant strains. Several compounds have been used for the treatment of HIV infections. Drug combinations are aimed to obtaining synergism between the compounds, while reducing the likelihood of drug resistance development. In This paper we reveiwed articles about the efficacy and safety of antiretroviral drugs combination regimens. The results of this survey demonstrated superior virologic, immunologic and morphologic effects of TENOFOVIR-emtricitabine regimen compared to other therapeutic regimens.

TENOFOVIR is an antiviral agent prescribed for patients suffering from hepatitis B. It is associated with some side effects such as reduction in the level of patients’ adherence. The aim of this study was to evaluate the impact of clinical pharmacist consultation on patients’ adherence to the use of TENOFOVIR. In this prospective study, a total of 80 patients were enrolled into the study and were divided into two groups. Patients in group one, received their medication in a routine clinic manner, while patients in the second group, by clinical pharmacist intervention, received TENOFOVIR along with verbal and written tips about the drug dosage, side effects, drug interactions, food-drug interactions and administration. Finally, patients’ adherence to their medication was evaluated using a standard scale. Also, adverse drug reaction (ADR) occurrence and some laboratory parameters were recorded for further analysis. The patients' adherence to their medication was higher in case group than the control group in first three month of follow up. Moreover, lower ADRs were observed in patients who received clinical pharmacist consultation. It can be concluded that consultation provided by clinical pharmacist can lead to better adherence to TENOFOVIR usage, better therapeutic response and better tolerance of side effects.

We present a 63-year-old woman with chronic hepatitis B. The patient has a history of cirrhosis due to chronic hepatitis B and is under treatment with TENOFOVIR disoproxil fumarate. The patient presented to our center with nausea, vomiting, and severe metabolic acidosis. After initial evaluation, along with the typical course of events and the exclusion of differential diagnoses of normal anion gap metabolic acidosis, we determined that the cause of illness was related to TENOFOVIR disoproxil fumarate. All our practical and laboratory data supported a diagnosis of proximal tubular acidosis. After discontinuing the drug for two weeks and providing supportive management, metabolic acidosis and electrolyte imbalance improved. The other isoform of TENOFOVIR (TENOFOVIR alafenamide) was initiated for the patient, and after two months of followup, there were no signs of acidosis or electrolyte imbalance.