title: The combination of tacrolimus and entecavir improves the remission of HBV-associated glomerulonephritis without enhancing viral replication.
abstract: BACKGROUND
  Tacrolimus inhibits hepatitis B virus entry into hepatocytes through targeting the HBV receptor, sodium taurocholate cotransporting polypeptide. This study was performed to evaluate the efficacy and safety of Tacrolimus combined with entecavir antiviral therapy for HBV-associated glomerulonephritis patients with biopsy-proven membranous nephropathy.
  
  
  METHODS
  A cohort of 42 patients was enrolled in this retrospective study. Twenty-three patients received Tacrolimus (0.05 mg/kg/day) in combination entecavir over 24 weeks, whereas the other 19 patients only received entecavir monotherapy.
  
  
  RESULTS
  The probability of proteinuria remission in the Tacrolimus+entecavir group was 69 and 87% after 12 and 24 weeks, whereas was only 26 and 42%, respectively, in the entecavir group. The mean time to partial or complete remission was 18.6 weeks in the Tacrolimus+entecavir group and 34.3 weeks in the entecavir group (P<0.001). A decrease in the HBV DNA titer was observed in all patients with active HBV replication. None of the HBV carriers in the Tacrolimus+entecavir group showed evidence of HBV reactivation. The serum creatinine and alanine aminotransferase levels remained stable in both groups. The Tacrolimus target trough concentration was 5-10 ng/mL.
  
  
  CONCLUSIONS
  Tacrolimus combined with entecavir rapidly and effectively induced remission of HBV-GN in Chinese adults. Furthermore, Tacrolimus may have a synergistic antiviral effect with entecavir.
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences Guangzhou, China.
authors.forename: Lifen
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences Guangzhou, China.
authors.forename: Zhiming
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences Guangzhou, China.
authors.forename: Huaban
authors.initials: H
authors.lastname: Liang
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences Guangzhou, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences Guangzhou, China.
authors.forename: Lixia
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences Guangzhou, China.
authors.forename: Zhonglin
authors.initials: Z
authors.lastname: Feng
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences Guangzhou, China.
authors.forename: Shuangxin
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences Guangzhou, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Shi
keywords: Glomerulonephritis; hepatitis B virus; membranous nephropathy; tacrolimus