Effect of Long-Term Use of Tenofovir (TDF) on Bone Density in Patients With Chronic Hepatitis B
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 172
- 试验地点
- 1
- 主要终点
- Percent Change in Bone Mineral Density (BMD)
研究概览
简要总结
This study aims to evaluate the effect of long-term use of Tenofovir Disoproxil Fumarate (TDF) on bone density in patients with chronic hepatitis B virus (HBV) infection. Tenofovir is a widely used antiviral medication for the treatment of HBV. While it is generally well tolerated, some studies have reported potential adverse effects on bone mineral density, particularly with long-term use.
The objective of this research is to assess whether extended TDF therapy is associated with reduced bone density or increased risk of osteopenia or osteoporosis in adult patients with chronic HBV infection. The study will involve clinical evaluation and radiological assessment of bone health using dual-energy X-ray absorptiometry (DEXA) scans, as well as relevant biochemical markers.
This investigation will provide important data on the long-term safety profile of Tenofovir in relation to bone health and help guide future clinical decisions for the management of chronic hepatitis B.
详细描述
Hepatitis B is a viral infection that affects approximately 257 million people worldwide, with an estimated 820,000 deaths annually due to HBV-related complications. It is a leading cause of liver cirrhosis and hepato-cellular carcinoma (HCC), making it a major global public health concern .
The diagnosis of Chronic Hepatitis B (CHB) is established by the persistence of Hepatitis B surface antigen (HBsAg) for more than six months . Some patients with chronic HBV infection may experience acute exacerbation, potentially progressing to acute-on-chronic liver failure (ACLF), a condition with a high mortality rate despite intensive supportive care and resource utilization. While liver transplantation is considered a potential life-saving treatment for ACLF, its widespread clinical application is limited due to donor shortages and high financial costs. Therefore, early intervention and treatment are crucial in managing patients with ACLF .
The primary goals of antiviral therapy in CHB are to suppress viral replication and promote the loss of HBV-related antigens . Currently, there are two major classes of antiviral agents approved for treating CHB: Interferon-Alpha and Nucleos(t)ide Analogues (NUCs). Among the NUCs, Entecavir (ETV), Tenofovir Disoproxil Fumarate (TDF), and Tenofovir Alafenamide (TAF) are the most widely used first-line treatments. These agents are effective, orally administered, and generally well-tolerated. However, long-term treatment is often required, as premature discontinuation may lead to virological relapse and liver failure.
TDF is considered one of the most potent antiviral agents against both HBV and HIV. However, it has been associated with bone toxicity, primarily through the development of osteoporosis via multiple mechanisms. Intracellular accumulation of TDF can lead to proximal tubular dysfunction and Fanconi syndrome, resulting in hypophosphatemic osteomalacia . Additionally, TDF has been shown to reduce osteoblast gene expression, impairing osteoblast function and decreasing bone formation .
Moreover, TDF-induced reduction in phosphate reabsorption in the proximal renal tubules can lead to bone disease, including hypouricemia and hypophosphatemia, ultimately contributing to osteomalacia and an increased risk of fractures. In contrast, TAF exhibits greater plasma stability, and therefore, its impact on renal and bone toxicity may be significantly lower
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 60 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Inclusion Criteria:
- •Adult male or female patients aged 18 to 60 years.
- •Diagnosed as HBV-positive.
- •Long-term use of Tenofovir Disoproxil Fumarate (TDF) for more than five years.
排除标准
- •Presence of other chronic liver diseases.
- •Diagnosed with Chronic Kidney Disease (CKD), regardless of etiology.
- •Patients who refuse to participate in the study.
- •Patients on combination therapy, including:
- •Interferon and Nucleoside analogue combination therapy.
- •Multiple nucleoside analogue combination therapy.
结局指标
主要结局
Percent Change in Bone Mineral Density (BMD)
时间窗: Baseline to 5 years post-TDF initiation
Change in BMD measured by dual-energy X-ray absorptiometry (DEXA), expressed as percentage change from baseline.
次要结局
未报告次要终点
研究者
Nour shaaban Mohamed Abd elrasoul
Principal Investigator
Assiut University