Published online Aug 27, 2023. doi: 10.4254/wjh.v15.i8.964
Peer-review started: March 20, 2023
First decision: May 18, 2023
Revised: May 26, 2023
Accepted: August 3, 2023
Article in press: August 3, 2023
Published online: August 27, 2023
Processing time: 154 Days and 16.1 Hours
In recent decades, the prevalence of nonalcoholic fatty liver disease (NAFLD) has significantly increased in China, leading to the coexistence of NAFLD and chronic hepatitis B (CHB). Many patients require long-term anti-hepatitis B virus (HBV) therapy with potent oral drugs tenofovir alafenamide (TAF) and entecavir (ETV), which are recommended as first-line treatment in HBV clinical practice guidelines. However, no studies have compared the effects of TAF and ETV on lipid profiles in HBV-treated patients. Meanwhile, there are limited data on the effects of TAF on metabolism-related complications in real-world settings.
Many patients require long-term anti-HBV therapy with the potent oral drugs TAF and ETV, which are recommended as first-line treatment in HBV clinical practice guidelines. TAF has a serum lipid-raising effect in patients with HIV; however, its effect on serum lipids and NAFLD risk in patients with CHB is unclear.
This retrospective cohort study aimed to characterize the effect of TAF on serum lipid levels and NAFLD risk in patients with CHB, and we compared the pretreatment and post-treatment serum lipid profile changes after initiation of either TAF or ETV anti-viral therapy.
The data including the clinical features, serum lipids, and metabolic factors of patients with CHB at baseline and approximately 1 year after TAF or ETV treatment were collected and analyzed. We used propensity score-matched models to assess the effects on high-density lipoprotein, low-density lipoprotein, triglycerides, and total cholesterol (TCHO).
Compared with the ETV group, the TAF group had significantly higher TCHO levels after treatment (4.67 ± 0.90 vs 4.36 ± 1.05, P=0.006). In a propensity score-matched model, TAF-treated patients had significantly increased TCHO levels compared to that at baseline (P = 0.019), while there was no difference for the ETV group. Body mass index, sex, hypertension, baseline TCHO, and creatine kinase-MB isoenzyme levels were significantly associated with elevated TCHO levels in logistic regression analysis. However, 1-year TAF treatment did not increase the incidence of NAFLD.
Our study found that a greater increase in TCHO was observed in patients with CHB receiving TAF than in those receiving ETV; however, TAF-induced dyslipidemia did not increase the incidence of NAFLD.
This was not a multicenter study, and most of patients with CHB in this study were Asians. Large-scale multicenter prospective studies should be conducted in the future to further evaluate the effects of CHB and anti-HBV therapies on the risk of dyslipidemia, NAFLD, cirrhosis, and hepatocellular carcinoma.