Lipid metabolism and renal function changes switching from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide therapy in CHB patients

Abstract

Abstract BACKGROUND Tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) are common antiviral treatments for chronic hepatitis B (CHB) patients. The effects of TAF therapy have not been clarified. AIM The study aimed to evaluate the changes caused by switching from TDF to TAF therapy, specifically on lipid metabolism and renal function in CHB patients. METHODS In this retrospective study, CHB patients receiving antiviral therapy, who were either switching from TDF to TAF therapy or continuing on TDF therapy were enrolled. Laboratory parameters were evaluated at baseline and 48 weeks after the enrollment. RESULTS Of 281 patients, the mean age was 43.02 years, with 73.31% males represented. One hundred fifty patients switched from TDF to TAF. After 48 weeks of post-enrollment treatment, total cholesterol (TCHO) and high density lipoprotein (HDL) profiles of the TAF group were increased compared with those continuing TDF therapy (4.58±0.88 vs 4.09±0.66, P=0.000; 1.31±0.35 vs 1.17±0.32, P=0.001; respectively). Additionally, the post-treatment TCHO level were significantly elevated compared with baseline levels (4.58±0.88 vs 4.47±0.87mmol/L, P=0.038) in the TAF-switching group. However, TCHO levels were significantly lower than at baseline levels in the continuing TDF group (P<0.002). Similarly, (low-density lipoprotein) LDL (P<0.042) and HDL (P<0.000) were also lowered in the continuing TDF group. Non-alcoholic fatty liver disease (NAFLD), baseline TCHO, baseline fasting blood glucose (FBG) and creatinine (CREA) were associated with the elevated TCHO in the TAF-switching group according to multivariable analysis. An increase in TCHO level was observed in CHB patients switching to TAF therapy after 48 weeks, though no significant changes in CREA or glomerular filtration rate (GFR) were observed compared with continuing TDF therapy. CONCLUSION This real-life retrospective cohort study of Chinese patients found a significant association of TAF on increasing serum lipid TCHO in CHB patients after 48 weeks of therapy. It is worth further exploring whether it is necessary to indiscriminately switch to TAF due to fear of the risk of kidney impairment.