Ning HB, Jin HM, Peng Z, Li K, Shang J. Bone and renal safety of initial antiviral therapy using tenofovir alafenamide fumarate or entecavir for chronic hepatitis B. World J Gastroenterol 2026; 32(22): 117500 [DOI: 10.3748/wjg.v32.i22.117500]
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Ning HB, Jin HM, Peng Z, Li K, Shang J. Bone and renal safety of initial antiviral therapy using tenofovir alafenamide fumarate or entecavir for chronic hepatitis B. World J Gastroenterol 2026; 32(22): 117500 [DOI: 10.3748/wjg.v32.i22.117500]
Hui-Bin Ning, Hui-Ming Jin, Zhen Peng, Kuan Li, Jia Shang, Department of Infectious Diseases, Henan Provincial People's Hospital, Zhengzhou 450000, Henan Province, China
Author contributions: Ning HB designed the research and wrote the first manuscript; Ning HB, Jin HM, Peng Z and Li K contributed to conceiving the research and analyzing data; Ning HB and Shang J conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethic Committee of Henan Provincial People's Hospital, No. 21, 2019.
Informed consent statement: All the study subjects provided informed consent.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
Received: January 6, 2026 Revised: January 29, 2026 Accepted: March 17, 2026 Published online: June 14, 2026 Processing time: 142 Days and 19.5 Hours
Abstract
BACKGROUND
Nucleoside/nucleotide analogs are currently the core drugs for antiviral treatment of chronic hepatitis B (CHB). Among them, entecavir (ETV) and tenofovir alafenamide fumarate (TAF) exhibit potent antiviral effects with low resistance rates and are recommended as first-line treatment regimens in domestic and international guidelines.
AIM
To evaluate bone and renal safety in patients with CHB receiving initial treatment with TAF or ETV.
METHODS
This study included 95 treatment-naive patients with CHB and were treated at the Infectious Diseases Department of Henan Provincial People’s Hospital from August 2019 to June 2020. They were assigned to either the TAF group (n = 45, 25 mg/day) or the ETV group (n = 50, 0.5 mg/day) according to the antiviral treatment plan. Patients’ basic clinical data were collected. Their bone mineral density, bone-related markers, and various renal function indicators were also measured and compared.
RESULTS
The study cohort had a mean age of 41.01 ± 11.67 years and a cirrhosis prevalence of 18.9%. At baseline, serum Ca (2.33 ± 0.13 vs 2.30 ± 0.15, t = 0.935, P = 0.352), serum P (1.12 ± 0.21 vs 1.12 ± 0.19, t = 0.026, P = 0.980), and 25-hydroxyvitamin D3 [25(OH)D] (22.67 ± 7.98 vs 24.96 ± 11.30, t = 1.122, P = 0.265) were comparable across groups. When the follow-up was extended to 96W, the abnormality rates of urinary A1M (4.4% vs 20.0%, χ2 = 5.193, P = 0.023), N-acetyl-beta-D-glucosaminidase (6.7% vs 24.0%, χ2 = 5.352, P = 0.021), and urine cystatin (4.4% vs 18.0%, χ2 = 4.251, P = 0.039) exhibited marked between-group differences.
CONCLUSION
For patients with CHB on long-term nucleoside drug use, comprehensive monitoring of bone and renal safety should be conducted as treatment duration increases. In this study, TAF outperforms ETV in renal tubular safety after long-term application.
Core Tip: Nucleoside/nucleotide analogs are currently the core drugs for the antiviral treatment of chronic hepatitis B (CHB). Among them, entecavir (ETV) and tenofovir alafenamide fumarate (TAF) are recommended as first-line treatment regimens in domestic and international guidelines due to their potent antiviral activity and low resistance rates. However, direct comparative data between TAF and ETV remain limited, particularly in long-term follow-up studies of Chinese CHB populations. The long-term differences in bone and renal safety between TAF and ETV warrant further investigation. Therefore, this study aims to provide critical insights for optimizing individualized treatment strategies for CHB by comparing the clinical efficacy and safety profiles of ETV and TAF.
