Efficacy of tenofovir alafenamide in HBeAg-positive chronic hepatitis B patients with low viremia
Objective To compare the efficacy of switching to or combining with tenofovir alafenamide fumarate(TAF)in the treatment of low-level viremia(LLV)in patients with hepatitis B e antigen(HBeAg)-positive chronic hepatitis B and explore the factors affecting viral response.Methods A retrospective analysis was performed on 73 HBeAg-positive chronic hepatitis B patients who developed LLV after treatment with entecavir(ETV)or tenofovir disoproxil fumarate(TDF)in the Affiliated Hospital of Xuzhou Medical University from June 2021 to June 2023.According to the treatment method,they were divided into TAF monotherapy group(n=45)or ETV combined with TAF group(n=28).They were followed up for 24 and 48 weeks.According to whether the patients had complete virogical response(CVR),they were divided into partial response group(n=25)and complete response group(n=48).The baseline characteristics and laboratory indicators between the two groups were analyzed by univariate analysis,and the independent influencing factors of patients'lack of complete viral response were analyzed by logistic regression.Results The CVR rate of the combination group was higher than that of the monotherapy group at week 24,and the difference was statistically significant(x2=4.073,P=0.044).There was no significant difference in the CVR rate between the two groups at week 48(x2=3.314,P＞0.05).In subgroup analysis,the CVR rate of the combination group in the TDF history group was higher than that of the monotherapy group at week 24,and the difference was statistically significant(P＜0.05).The baseline HBV DNA,HBeAg in each group,HBsAg in each group,and alanine aminotransferase,aspartate aminotransferase at week 24 in the partial response group were significantly higher than those in the complete response group(t/Z=3.848,3.900,3.913,2.678,2.059;all P＜0.05).The proportion of TDF history in the partial response group was significantly higher than that in the complete response group(x2=5.017,P=0.025).Baseline HBV DNA and TDF use history were independent predictors of patients not achieving complete response within 48 weeks of treatment(P=0.015,OR:7.849,95％CI:1.483-41.534;P=0.039,OR:5.503,95％CI:1.091-27.757).Conclusions Switching to or combining with TAF could effectively improve the probability of complete viral response in HBeAg-positive patients with low viremia;ETV combined with TAF had a better complete response rate at 24 weeks than TAF alone.Baseline HBV DNA and TDF use history were independent predictors of patients not achieving complete response within 48 weeks of treatment.
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