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J. Med. Virol., 28 June 2024 | https://doi.org/10.1002/jmv.29760
Metabolic effects and cardiovascular disease risks of antiviral treatments in patients with chronic hepatitis B
Hyunjae Shin 1,2, Gyung Sun Lim 1, Jae Woong Yoon 1, Yunmi Ko 1, Youngsu Park 1, Jeayeon Park 1, Moon Haeng Hur 1, Min Kyung Park 1, Yuri Cho 2, Yun Bin Lee 1, Eun Ju Cho 1, Bo Hyun Kim 2, Jeong-Hoon Lee 1, Su Jong Yu 1, Jung-Hwan Yoon 1, Yoon Jun Kim 1
1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
2Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, South Korea.
CORRESPONDING AUTHOR : Yoon Jun Kim
Abstract
Different antiviral treatments for chronic hepatitis B (CHB) have been known to have different metabolic effects. This study aimed to reveal whether tenofovir alafenamide (TAF)-induced dyslipidemia and its associated outcomes are significant. This study utilized 15-year historical cohort including patients with CHB in Korea and consisted of two parts: the single-antiviral and switch-antiviral cohorts. In the single-antiviral cohort, patients were divided into four groups (entecavir [ETV]-only, tenofovir disoproxil fumarate [TDF]-only, TAF-only, and non-antiviral). Propensity score matching (PSM) and linear regression model were sequentially applied to compare metabolic profiles and estimated atherosclerotic cardiovascular disease (ASCVD) risks longitudinally. In the switch-antiviral cohort, pairwise analyses were conducted in patients who switched NAs to TAF or from TAF. In the single-antiviral cohort, body weight and statin use showed significant differences between groups before PSM, but well-balanced after PSM. Changes in total cholesterol were significantly different between groups (-2.57 mg/dL/year in the TDF-only group and +2.88 mg/dL/year in the TAF-only group; p = 0.002 and p = 0.02, respectively). In the TDF-only group, HDL cholesterol decreased as well (-0.55 mg/dL/year; p < 0.001). The TAF-only group had the greatest increase in ASCVD risk, followed by the TDF-only group and the non-antiviral group. In the switch-antiviral cohort, patients who switched from TDF to TAF had a higher total cholesterol after switching (+9.4 mg/dL/year) than before switching (-1.0 mg/dL/year; p = 0.047). Sensitivity analysis on data with an observation period set to a maximum of 3 years for NA treatment showed consistent results on total cholesterol (-2.96 mg/dL/year in the TDF-only group and +3.09 mg/dL/year in the TAF-only group; p = 0.001 and p = 0.005, respectively). Another sensitivity analysis conducted on statin-treated patients revealed no significant change in cholesterol and ASCVD risk. TAF was associated with increased total cholesterol, whereas TDF was associated with decreased total and HDL cholesterol. Both TAF and TDF were associated with increased ASCVD risks, and statin use might mitigate these risks.
논문정보
- Research article
- 2024년 06월 (BRIC 등록일 2024-06-30)
- 국내 연구진
- 의약학 > 응용의학
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