The impact of switching to tenofovir alafenamide on lipid profile and renal function in chronic hepatitis B: a retrospective cohort study.

摘要

OBJECTIVE: Tenofovir alafenamide (TAF) offers favorable renal safety compared with tenofovir disoproxil fumarate (TDF) in chronic hepatitis B (CHB), but its long-term metabolic effects remain unclear. This study aimed to assess changes in lipids, atherogenic indices, fibrosis markers, and renal function after switching to TAF and identify baseline factors associated with lipid changes. METHODS: This single-center retrospective cohort included CHB patients treated with TDF or entecavir for ≥24 months, switched to TAF, and followed for ≥24 months. Patients with diabetes, dyslipidemia, or chronic kidney disease were excluded. Parameters were assessed 5 times over 2 years before and after switching. Mixed-effects models and Wilcoxon signed-rank tests assessed trends and pre-post changes. RESULTS: Fifty-nine patients were included (mean age, 52.7 ± 9.9 years; 91.5% previously on TDF). Lipid fractions increased, particularly total cholesterol (median Δ, +22.81 mg/dL; P < 0.001) and low-density lipoprotein (LDL) cholesterol (+14.29 mg/dL; P < 0.001). Ratio-based indices, including the atherogenic index of plasma (AIP), triglyceride/high-density lipoprotein (HDL), LDL/HDL, and non-HDL/HDL, remained stable. However, 22.0% crossed the AIP risk threshold, and 16.9% exceeded LDL and non-HDL cutoffs. Younger age and lower baseline LDL or HDL were associated with greater increases. Estimated glomerular filtration rate remained stable; creatinine rose without clinical significance. CONCLUSION: Switching to TAF was associated with clinically meaningful increases in absolute lipid fractions without worsening atherogenic ratios or renal function. Nevertheless, a minority transitioned to higher cardiometabolic risk categories, supporting individualized lipid monitoring, particularly in younger patients and those with low baseline LDL or HDL.