title: Substitution of tenofovir/emtricitabine for Hepatitis B immune globulin prevents recurrence of Hepatitis B after liver transplantation.
abstract: BACKGROUND
  Hepatitis B immune globulin (HBIg) with or without nucleos(t)ide analogue (NA) inhibitors has been shown to prevent recurrence of hepatitis B virus (HBV) following orthotopic liver transplantation (OLT). However, the use of HBIg has many disadvantages.
  
  
  OBJECTIVE
  The present study was performed to determine if converting patients from HBIg ± NA to combination NA therapy could prevent recurrence of HBV.
  
  
  METHODS
  Twenty-one recipients without evidence of HBV recurrence on HBIg ± NA for ≥ 6 months were enrolled. Patients received their last injection of HBIg at the time they initiated tenofovir disoproxil fumarate/emtricitabine (TDF/FTC; Truvada(®) ) and were followed up for 31.1 ± 9.0 [range 15-47] months.
  
  
  RESULTS
  After 1 year, 3 patients (14%) had detectable HBsAg, one of whom was non-compliant. Two of 3 with recurrence cleared HBsAg by last follow-up on TDF/FTC; the non-compliant patient became HBV DNA-undetectable with re-institution of TDF/FTC. TDF/FTC saved $12,469/year over our standard-of-care, monthly intramuscular HBIg/lamivudine. There was no evidence of a general adverse effect of TDF/FTC on renal function. However, 3 patients developed reversible acute renal failure; on renal biopsy, 1 had possible TDF/FTC-induced acute tubular necrosis.
  
  
  CONCLUSIONS
  Substitution of TDF/FTC for HBIg prevented recurrence of HBV DNA in 100% (20/20) of patients who were compliant with the medication and led to substantial cost savings over HBIg-containing regimens.
authors.affiliation: Section of Hepatology, Division of Gastroenterology, Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA 23298-0341, USA. rstravit@vcu.edu
authors.forename: R Todd
authors.initials: RT
authors.lastname: Stravitz
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Shiffman
authors.forename: Melissa
authors.initials: M
authors.lastname: Kimmel
authors.forename: Puneet
authors.initials: P
authors.lastname: Puri
authors.forename: Velimir A
authors.initials: VA
authors.lastname: Luketic
authors.forename: Richard K
authors.initials: RK
authors.lastname: Sterling
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Cotterell
authors.forename: Marc P
authors.initials: MP
authors.lastname: Posner
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D000068679:Emtricitabine; D005260:Female; D006509:Hepatitis B / Q000191:economics / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D007136:Immunoglobulins / Q000191:economics / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000191:economics / Q000627:therapeutic use*; D055502:Secondary Prevention; D000068698:Tenofovir
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D063065:Organophosphonates; D003841:Deoxycytidine; D000068698:Tenofovir; D000068679:Emtricitabine; D000225:Adenine