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Abstract
Background The effects of tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) on lipid metabolism in patients with coexisting chronic hepatitis B (CHB) and metabolic-associated steatotic liver disease (MASLD) are unclear. This study aims to clarify the impact of TDF and TAF on lipid metabolism after 96 weeks of treatment in this specific population.
Methods This propensity score matching (PSM) cohort included MASLD and CHB patients who received TDF or TAF monotherapy for over 96 weeks between July 2019 and February 2023 at Beijing Ditan Hospital. PSM aligned important baseline clinical characteristics through 1:1 nearest-neighbor matching using a caliper of 0.2. The primary outcome was changes in lipid profiles over 96 weeks between groups. The secondary outcome was the 10-year atherosclerotic cardiovascular disease (ASCVD) risk.
Results Among 158 CHB patients with MASLD enrolled (TDF=79, TAF=79 based on PSM), the median age was 42 years, and 81% were male. Baseline variables, including biochemical markers, severity of steatosis, and 10-year ASCVD risk, were well balanced. When comparing the median levels of each parameter between the two groups at week 96 (IDDF2024-ABS-0400 Figure 1. Dynamic changes in major lipid profiles and ASCVD risk), the TAF group had significantly higher total cholesterol (TC) (4.8 vs. 4.3 mmol/L, p<0.001), low-density lipoprotein cholesterol (3.1 vs. 2.9 mmol/L, p=0.02), triglycerides (1.5 vs. 1.2 mmol/L, p<0.001), apolipoprotein A1 (ApoA1) (1.4 vs. 1.3 g/L, p<0.01), and apolipoprotein B (0.9 vs. 0.8 g/L, p<0.01). However, the median 10-year ASCVD risk scores were similar (TAF 2.4 vs. TDF 2.8, p=0.33), and high-risk proportions were comparable (TAF 12.8% vs. TDF 6.3%, p=0.17) at 96 weeks. Compared to baseline, the TAF group only had a significant increase in median ApoA1 at weeks 48 and 96, while the TDF group had significant decreases in TC and ApoA1 at 48 weeks, which returned to baseline levels by 96 weeks.
Dynamic changes in major lipid profiles and ASCVD risk
Conclusions In CHB patients with MASLD, there were significant differences in lipid parameters between the TDF and TAF groups after 96 weeks, although both groups had comparably low 10-year ASCVD risk.