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頁籤選單縮合
題名 | 疑似Darunavir/ritonavir引起肝炎再發作之案例=A Case Report of Suspected Darunavir with Ritonavir Induced Recurrence of Hepatitis |
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作者姓名(中文) | 林聖茹; 謝政智; 王甯祺; | 書刊名 | 藥學雜誌 |
卷期 | 34:1=134 2018.03[民107.03] |
頁次 | 頁95-102 |
分類號 | 418.285 |
關鍵詞 | B型肝炎; Darunavir; Ritonavir; Protease inhibitors; |
語文 | 中文(Chinese) |
中文摘要 | Darunavir/ritonavir 兩者皆屬於 HIV-1蛋白酶抑制劑 (protease inhibitors, PI),具選擇 性地與 HIV-1蛋白酶的活性部位結合進而抑制病毒 Gag-Pol polyprotein 前驅物的分裂反 應,遏阻成熟病毒顆粒的形成。Ritonavir 具有強的 CYP3A 抑制能力,常以低劑量100- 200 mg 與其它 PI 併用,可加強其他 PI 的藥物血中濃度以提高療效 (boosted PI)。然有 0.5%的病人會因為使用 darunavir/ritonavir 引起肝炎反應 (如急性肝炎、細胞溶解性肝 (包括嚴重的肝臟不良事件) 的風險則會更高1。 本案例報導一位40歲B型肝炎帶原之男性 HIV 感染者,過去曾有巨細胞病毒感染 史,因對多種抗反轉錄病毒藥物具有抗藥性,接受 darunavir/ritonavir 及 raltegravir 長 達2-3個月。病人肝功能在用藥前原先都處於正常值,直到開始使用 darunavir/ritonavir 及 raltegravir 2-3個月後,血清轉胺酶 (Aspartate aminotransferase, AST;Alanine aminotransferase, ALT) 及 total bilirubin 分別上升至244 U/L、206 U/L 及7.7 mg/dL,推測可能原因與病人本身有慢性B型肝炎病史,使用 darunavir/ritonavir 誘發肝炎發作有 關。本文後續將討論此病人使用 darunavir/ritonavir 發生肝功能異常的可能機制以及預 後,提醒臨床醫療人員對於使用 darunavir/ritonavir 有發生肝功能異常之風險。 |
英文摘要 | Protease inhibitors (PIs) act selectively binding to the active site of human immunodeficiency virus (HIV)-1 protease, inhibiting the cleavage of the virus Gag-Pol polyprotein precursor, and then preventing the formation of mature virus particles. Darunavir and ritonavir both are PIs. Ritonavir has highly Cytochrome P450 3A inhibitory capacity and is often used in combined to other PIs to increase the serum drug concentration. A HIV positive patient with hepatitis B or C who used darunavir and ritonavir may has higher risk of abnormal liver function or severe hepatic adverse events. A case report of a hepatitis B and HIV male carrier with the past history of cytomegalovirus infection and multiple antiretroviral drugs resistance used darunavir, ritonavir and raltegravir for 2-3 months. The liver functions (aspartate aminotransferase and alanine aminotransferase) and total serum bilirubin increased to 244 U/L, 206 U/L and 7.7 mg/dL, respectively. The possible mechanisms of drug reactions have been discussed and remind to health care professionals being aware. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。