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Abstract Details
Hepatitis B virus (HBV) viral load, liver and renal function in adults treated with tenofovir disoproxil fumarate (TDF) vs. untreated: a retrospective longitudinal UK cohort study
BMC Infect Dis. 2021 Jun 26;21(1):610. doi: 10.1186/s12879-021-06226-0.
Tingyan Wang12, David A Smith23, Cori Campbell12, Jolynne Mokaya1, Oliver Freeman24, Hizni Salih24, Anna L McNaughton1, Sarah Cripps5, Kinga A Várnai23, Theresa Noble23, Kerrie Woods23, Jane Collier6, Katie Jeffery7, Jim Davies28, Eleanor Barnes#910, Philippa C Matthews#111213
Author information
1Nuffield Department of Medicine, University of Oxford, Oxford, UK.
2National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, UK.
3NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
4Nuffield Department of Population Health, University of Oxford, Oxford, UK.
5Pharmacy Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
6Department of Hepatology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
7Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
8Department of Computer Science, University of Oxford, Oxford, UK.
9Nuffield Department of Medicine, University of Oxford, Oxford, UK. ellie.barnes@ndm.ox.ac.uk.
10NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. ellie.barnes@ndm.ox.ac.uk.
11Nuffield Department of Medicine, University of Oxford, Oxford, UK. philippa.matthews@ndm.ox.ac.uk.
12NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. philippa.matthews@ndm.ox.ac.uk.
13Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. philippa.matthews@ndm.ox.ac.uk.
#Contributed equally.
Abstract
Background: Current clinical guidelines recommend treating chronic hepatitis B virus (HBV) infection in a minority of cases, but there are relatively scarce data on evolution or progression of liver inflammation and fibrosis in cases of chronic HBV (CHB) that do not meet treatment criteria. We aimed to assess the impact of TDF on liver disease, and the risk of renal impairment in treated CHB patients in comparison to untreated patients.
Methods: We studied a longitudinal ethnically diverse CHB cohort in the UK attending out-patient clinics between 2005 and 2018. We examined TDF treatment (vs. untreated) as the main exposure, with HBV DNA viral load (VL), ALT, elastography scores and eGFR as the main outcomes, using paired tests and mixed effects model for longitudinal measurements. Additionally, decline of eGFR during follow-up was quantified within individuals by thresholds based on clinical guidelines. Baseline was defined as treatment initiation for TDF group and the beginning of clinical follow-up for untreated group respectively.
Results: We included 206 adults (60 on TDF, 146 untreated), with a median ± IQR follow-up duration of 3.3 ± 2.8 years. The TDF group was significantly older (median age 39 vs. 35 years, p = 0.004) and more likely to be male (63% vs. 47%, p = 0.04) compared to the untreated group. Baseline difference between TDF and untreated groups reflected treatment eligibility criteria. As expected, VL and ALT declined significantly over time in TDF-treated patients. Elastography scores normalised during treatment in the TDF group reflecting regression of inflammation and/or fibrosis. However, 6/81 (7.4%) of untreated patients had a progression of fibrosis stage from F0-F1 to F2 or F3. There was no evidence of difference in rates or incidence of renal impairment during follow-up in the TDF vs. untreated group.
Conclusions: Risk of liver inflammation and fibrosis may be raised in untreated patients compared to those receiving TDF, and TDF may benefit a larger percentage of the CHB population.