Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan.
Department of Gastroenterology, Hakodate Municipal Hospital, Hokkaido, Japan.
PLoS One. 2022 Jan 20;17(1):e0261760. doi: 10.1371/journal.pone.0261760. eCollection 2022.
For long-term treatment of hepatitis B virus (HBV) infection, switching from tenofovir-disoproxil-fumarate (TDF) to tenofovir-alafenamide (TAF) may prevent renal dysfunction and bone loss. However, the precise effects of this switch on the blood lipid profile remain to be clarified. This is an important issue as TDF is known to have effects on both low- and high-density lipids. Therefore, our retrospective multi-center study aimed to evaluate the effects of switching from TDF to TAF on the lipid profile of patients with HBV infection. Samples were obtained prior to the switch from TDF to TAF and at 6-12 months after TAF initiation. In some cases, additional samples obtained pre- and post-TDF administration were available for analysis. Serum cholesterol levels, including oxidized-low-density lipoprotein (LDL) and non-high-density lipoprotein-cholesterol (HDL-c), and the rate of dyslipidemia, according to the NCEP-ATP III lipid risk classification, were analyzed. The data from 69 patients were analyzed, including 33 patients with pre- and post-TDF-initiation serum samples. Total cholesterol (T-chol), HDL-c, LDL-c, non-HDL-c, and oxidized LDL levels increased significantly after switching to TAF. With regard to sequential changes pre- to post-TAF, TDF was associated with significantly lower serum T-chol, HDL-c, and oxidized LDL-c levels, with T-chol, HDL-c, LDL-c, and oxidized LDL-c levels increasing significantly after the switch. The switch from TDF to TAF was also associated with an increase in the rate of dyslipidemia, from 33% to 39%, with an increase in the rate of severe dyslipidemia of 1.4% and 5.8%, based on T-chol and LDL-c levels. Of note, no cases of severe dyslipidemia were detected pre-TAF treatment. As oxidized LDL-c and non-HDL-c are strongly associated with atherosclerosis development, careful monitoring of lipid is needed after switching from TDF to TAF in this clinical population.
对于乙型肝炎病毒（HBV）感染的长期治疗，从替诺福韦二吡呋酯（TDF）转换为替诺福韦艾拉酚胺（TAF）可能预防肾功能障碍和骨丢失。然而，这种转换对血脂谱的确切影响仍需阐明。这是一个重要的问题，因为 TDF 已知对低和高密度脂蛋白均有影响。因此，我们的回顾性多中心研究旨在评估从 TDF 转换为 TAF 对 HBV 感染患者血脂谱的影响。在从 TDF 转换为 TAF 之前和 TAF 开始后 6-12 个月采集样本。在某些情况下，还可以获得 TDF 给药前后的额外样本进行分析。分析了血清胆固醇水平，包括氧化型低密度脂蛋白（LDL）和非高密度脂蛋白胆固醇（HDL-c），以及根据 NCEP-ATP III 脂质风险分类的血脂异常发生率。分析了 69 例患者的数据，其中包括 33 例有 TDF 起始前和起始后血清样本的患者。转换为 TAF 后，总胆固醇（T-chol）、HDL-c、LDL-c、非 HDL-c 和氧化型 LDL 水平显著升高。关于 TAF 前后的顺序变化，TDF 与血清 T-chol、HDL-c 和氧化型 LDL-c 水平显著降低相关，转换后 T-chol、HDL-c、LDL-c 和氧化型 LDL-c 水平显著升高。从 TDF 转换为 TAF 也与血脂异常发生率的增加相关，从 33%增加到 39%，基于 T-chol 和 LDL-c 水平，严重血脂异常的发生率增加了 1.4%和 5.8%。值得注意的是，在 TAF 治疗前未检测到严重血脂异常病例。由于氧化型 LDL-c 和非 HDL-c 与动脉粥样硬化的发展密切相关，因此在该临床人群中从 TDF 转换为 TAF 后需要密切监测血脂。
