gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1450Research ArticleГЕПАТОЛОГИЯHEPATOLOGYОпыт применения энтекавира для лечения хронического гепатита В у реципиентов почечного трансплантатаExperience of entecavir in renal graft recipients with chronic hepatitis BЗубкинМ. Л.ZubkinM. L.СельковаЕ. П.Sel'kovaYe. P.КокоеваФ. К.KokoyevaF. K.СемененкоТ. А.SemenenkoT. A.ЧервинкоВ. И.ChervinkoV. I.КоломоецА. Н.KolomoyetsA. N.БалакиревЭ. М.BalakirevE. M.ФроловА. В.FrolovA. V.НекрасоваТ. П.NekrasovaT. P.2011120920112155257Copyright © Зубкин М.Л., Селькова Е.П., Кокоева Ф.К., Семененко Т.А., Червинко В.И., Коломоец А.Н., Балакирев Э.М., Фролов А.В., Некрасова Т.П., 20112011Зубкин М.Л., Селькова Е.П., Кокоева Ф.К., Семененко Т.А., Червинко В.И., Коломоец А.Н., Балакирев Э.М., Фролов А.В., Некрасова Т.П.Zubkin M.L., Sel'kova Y.P., Kokoyeva F.K., Semenenko T.A., Chervinko V.I., Kolomoyets A.N., Balakirev E.M., Frolov A.V., Nekrasova T.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1450Цель исследования

Цель исследования. Оценить эффективность и безопасность энтекавира (ETV) при хроническом гепатите В (ХГВ) у реципиентов почечного трансплантата (РПТ).

Материал и методы

Материал и методы. В среднем через 71,5±36,9 мес после трансплантации почки 4 РПТ с ХГВ получали лечение энтекавиром. У 2 больных с биохимической ремиссией ХГВ на фоне предшествующего лечения ламивудином (LAM) и развившейся YVDD мутацией доза ETV составила 1 мг/сут. Один из них был HBeAg-негативным до начала лечения LAM, а у другого сероконверсия HBeAg произошла на фоне лечения LAM. Вирусная нагрузка до назначения энтекавира у этих больных была 1,6×103 и 3,9×104 копий/мл соответственно.Двум другим «naive» РПТ c HBeAg-позитивным ХГВ, также инфицированным HCV, энтекавир был назначен в дозе 0,5 мг/сут. Активность АлАТ была 98 и 149 ME/л, вирусная нагрузка HBV – 1,6×109 и 1,0×108 копий/мл. У всех пациентов определялась стадия фиброза 1 по шкале METAVIR. Расчетная скорость клубочковой фильтрации превышала 60 мл/мин.

Результаты

Результаты. Продолжительность лечения ETV у 2 РПТ (в прошлом получавших LAM) с нормальными показателями АлАТ и низкой вирусной нагрузкой составила 13 и 23 мес. Через 6 мес после начала терапии у этих больных в крови перестала определяться ДНК HBV. Длительность терапии ETV у «naive» больных составила 26 и 24 мес. Биохимическая ремиссия развилась через 10 и 15 мес после начала лечения. Вирусная нагрузка неуклонно снижалась и через 25 и 23 мес соответственно была достигнута элиминация ДНК HBV. У одного из этих пациентов произошла сероконверсия HBeAg. Во время терапии нежелательных явлений не отмечено. Функция трансплантата оставалась стабильной у 3 пациентов и снизилась у одного больного после развития острого криза отторжения на фоне уменьшения дозы иммуносупрессивных препаратов.

Заключение

Заключение. Энтекавир показал высокую эффективность и безопасность у ограниченного числа РПТ с ХГВ в условиях кратковременного курса лечения.

Aim of investigation

Aim of investigation. To estimate efficacy and safety of entecavir (ETV) in chronic hepatitis B (CHB) at renal graft recipients (RGR).

Material and methods

Material and methods. Four RGR with CHB on in mean 71,5±36,9 month after kidney transplantation received treatment by entecavir. In 2 patients with CHB biochemical remission on background of previous lamivudine (LAM) treatment, who developed YVDD mutation ETV dose was 1 mg/day. One of them was HBeAgnegative prior to onset of LAM treatment, and the other developed HBeAg seroconversion while being at LAM treatment. The viral load before prescription of entecavir at these patients was 1,6×103 and 3,9×104 copies/ml respectively. Two other «naive» RGR with HBeAg-positive CHB, that were infected by HCV as well, received 0,5 mg/ day of entecavir. Activity of ALT was 98 and 149 IU/l, HBV viral load – 1,6×109 and 1,0×108 copies/ml. In all patients stage 1of fibrosis by METAVIR scale was determined. Calculated glomerular filtration rate was over 60 ml/min.

Results

Results. Duration of ETV treatment in 2 RGR (that previously received LAM) with normal ALT level and low viral load was 13 and 23 months. In 6 months after treatment onset HBV DNA was not determined in blood of these patients. Duration of ETV treatment at «naive» patients was 26 and 24 months. Biochemical remission developed in 10 and 15 months after the start treatment. The viral load steadily dropped and HBV DNA elimination has been achieved in 25 and 23 months respectively. One of these patients had HBeAg seroconversion. During treatment no undesirable effects were marked. Function of renal graft remained stable in 3 patients and decreased in one case patient after development of acute rejection crisis on a background of decrease of dose of immune suppressants.

Conclusion

Conclusion. Entecavir demonstrated high effectiveness and safety at limited number of RGR with CHB in short-term course of treatment.

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The authors declare that there are no conflicts of interest present.