Effectivity and safety of TAF in CHB patients with concurrent MASLD: a real-world study

BACKGROUND AND AIM: The overlapping prevalence of chronic hepatitis B (CHB) and metabolic dysfunction-associated steatotic liver disease (MASLD) is high, increasing the risk of liver complications. However, data on whether antiviral therapy influences lipid profiles are limited. Therefore, this study aimed to investigate the efficacy and safety of tenofovir alafenamide (TAF) in treatment-naïve CHB patients with MASLD. METHODS: A retrospective analysis was conducted on 96 treatment-naïve CHB patients with MASLD who received TAF monotherapy. Clinical data were collected at baseline and at 12, 24, 36, and 48 weeks after treatment initiation. Changes in HBV DNA, ALT, AST, HBsAg, TBIL, ALB, liver stiffness measurement (LSM), controlled attenuation parameter (CAP), lipid biomarkers (HDL, LDL, TG, TC), and renal markers (BUN, Cr, β2-microglobulin) were compared before and after treatment. RESULTS: A total of 96 treatment-naïve CHB patients with MASLD (56 males and 40 females) were eligible and enrolled. The mean age was 50.69 ± 10.89 years, with ALT and AST levels of 90.54 ± 17.76 U/L and 74.01 ± 15.09 U/L, respectively. The rates of undetectable HBV DNA at 12, 24, 36, and 48 weeks were 67.71%, 72.92%, 91.67%, and 96.88%, respectively, all significantly different from baseline (P < 0.001). After 48 weeks of TAF treatment, ALT levels decreased significantly from 90.54 ± 17.76 U/L to 30.81 ± 16.06 U/L (P = 0.001), and AST levels decreased from 74.01 ± 15.09 U/L to 24.78 ± 14.95 U/L (P = 0.002). HBsAg quantification decreased from 6061.29 ± 972.96 IU/mL to 3621.11 ± 699.54 IU/mL (P = 0.047). LSM decreased from 6.53 ± 1.52 kPa to 5.96 ± 1.67 kPa (P = 0.01), and CAP decreased from 299.09 ± 26.44 dB/m to 290.04 ± 28.38 dB/m (P = 0.023). No significant changes were observed in TBIL, ALB, lipid biomarkers (HDL, LDL, TG, TC), or renal function markers (BUN, Cr, β2-microglobulin) throughout the treatment period. CONCLUSION: TAF treatment in treatment-naïve CHB patients with MASLD effectively suppressed viral replication, showed a trend toward improving liver stiffness, and has no adverse effects on lipid profiles or renal function.