A recent study published in the Virology Journal has highlighted a potential risk of dyslipidemia in chronic hepatitis B (CHB) patients treated with tenofovir alafenamide fumarate (TAF). The research, which compared TAF to tenofovir disoproxil fumarate (TDF), found a significantly higher incidence of dyslipidemia, elevated triglycerides (TG), and total cholesterol (TC) levels in the TAF group.
The study involved 430 treatment-naïve CHB patients, with 158 receiving TAF and 272 receiving TDF. Baseline characteristics showed that the TAF group had significantly higher TC levels (4.2 mmol/L vs. 4.0 mmol/L, P = 0.022) but lower ALT and AST levels compared to the TDF group. The follow-up duration was slightly longer in the TDF group (18.0 months vs. 16.0 months, P = 0.001).
Increased Incidence of Dyslipidemia with TAF
During the follow-up period, 42 patients in the TAF group developed dyslipidemia, with incidence rates of 12.3 and 15.8 per 100 person-years for elevated TG and TC, respectively. In contrast, the TDF group saw only 29 patients develop dyslipidemia, with significantly lower incidence rates of elevated TG (4.9 per 100 person-years) and TC (2.2 per 100 person-years). Kaplan-Meier analysis confirmed significantly higher cumulative incidences of dyslipidemia, elevated TG, and TC in the TAF group (P < 0.001 for all).
Changes in Lipid Profiles
Fasting TG and TC levels significantly increased from baseline to the end of follow-up in the TAF group (TG: 0.83 mmol/L to 1.02 mmol/L, P < 0.001; TC: 4.16 mmol/L to 4.32 mmol/L, P < 0.001). Conversely, TC levels significantly decreased in the TDF group (4.05 mmol/L to 3.78 mmol/L, P < 0.001), while TG levels remained stable. Further analysis revealed that TG and TC levels in the TAF group were significantly higher than those in the TDF group after 6, 12, 18, and 24 months of treatment (all P < 0.05).
Factors Associated with Dyslipidemia
Cox regression analysis identified TAF treatment (HR = 3.950, 95% CI: 2.157–7.232, P < 0.001), baseline TG level (HR = 4.030, 95% CI: 1.755–9.258, P = 0.001), baseline TC level (HR = 2.878, 95% CI: 1.624–5.098, P < 0.001), and platelet count (PLT) as independent factors associated with dyslipidemia. Similar results were observed in the propensity score matching (PSM) cohort.
Clinical Implications
The study's findings suggest that TAF treatment in CHB patients is associated with a higher risk of developing dyslipidemia compared to TDF. This is clinically significant because dyslipidemia is a major risk factor for cardiovascular diseases. Healthcare providers should carefully monitor lipid profiles in CHB patients undergoing TAF therapy, especially those with pre-existing risk factors for dyslipidemia. Further research is needed to understand the underlying mechanisms and long-term cardiovascular outcomes associated with TAF-induced dyslipidemia in CHB patients.
