著者

櫛田 宏幸 中内 崇夫 矢倉 裕輝 渡邊 大 上平 朝子 白阪 琢磨

出版者

一般社団法人 日本感染症学会

雑誌

感染症学雑誌 (ISSN:03875911)

巻号頁・発行日

vol.95, no.3, pp.319-323, 2021-05-20 (Released:2021-11-26)

参考文献数

15

---

Tenofovir disoproxil fumarate(TDF)is a prodrug of tenofovir(TFV), used in the treatment of hepatitis B(HBV)and HIV-1. TFV is a renally excreted drug;a weekly dose of 300mg is recommended for patients suffering from HIV/HBV co-infection and undergoing hemodialysis(HD)for renal failure. The pharmacokinetics of TFV in Japanese patients undergoing HD has not yet been thoroughly explored. Herein, we report a case of HD in which the plasma concentrations of TFV were measured serially after the start of treatment with TDF. An 80-year-old Japanese man with HIV-1 was undergoing HD thrice weekly for end-stage renal failure. Concomitantly, the patient was receiving treatment with darunavir ethanolate, ritonavir, and raltegravir potassium for HIV-1 infection. With the treatment, the blood HIV-RNA levels had decreased to below 20 copies/mL. However, the patient developed acute HBV while under follow-up as an outpatient. He was started on treatment with TDF/emtricitabine, administered once weekly after HD, as treatment for HBV. The 7-day TFV trough concentrations measured in two consecutive weeks were 54 and 45ng/mL. The values were comparable with those in the general Japanese population(non-HD subjects)and to other previous reports. The treatment resulted in suppression of both HIV-1 and HBV. However, based on the combination of drugs and HD conditions, the dialysis clearance and removal rates vary. In conclusion, measurement of the plasma drug concentrations is useful for appropriate and definitive treatment of HIV-1 and HBV in patients undergoing HD.