Semi-quantitative ultrasound scoring reveals hepatic structural recovery and immune modulation during tenofovir alafenamide therapy in chronic hepatitis B

Objective This study aimed to evaluate the therapeutic response to tenofovir alafenamide fumarate (TAF) in chronic hepatitis B (CHB) using a semi-quantitative ultrasound (US) scoring system, and to investigate the correlation between sonographic changes and immune function restoration. Methods A total of 100 CHB patients who received TAF monotherapy (25 mg/day) for at least 24 months were retrospectively enrolled. A seven-parameter semi-quantitative US score, encompassing liver echogenicity, capsular contour, margin shape, vessel clarity, portal vein diameter (PVD), spleen thickness (ST), and splenic vein velocity (SVV), was calculated at baseline, 12 months, and 24 months. Concurrently, serum hepatitis B virus (HBV) deoxyribonucleic acid (DNA), alanine aminotransferase (ALT), aspartate aminotransferase (AST), peripheral T-cell subsets, including cluster of differentiation 3-positive (CD3 + ), CD4 + , CD8 + T cells, CD4+/CD8+ ratio, and natural killer (NK) cell activity were measured. Correlations between US scores and biochemical/immune parameters were analyzed. Results At 24 months, all patients achieved HBV DNA <20 IU/mL, with ALT and AST normalization rates of 92% and 95%, respectively. The comprehensive US score decreased significantly from 7.86 ± 1.73 at baseline to 3.37 ± 0.95 at 24 months ( P < 0.001), with the most pronounced improvements observed in capsular smoothness and parenchymal homogeneity. The CD4 + T-cell proportion and CD4 + /CD8 + ratio increased, whereas the CD8 + proportion decreased; NK cell activity rose from 42.7 ± 7.3% to 52.4 ± 6.2% ( P < 0.05). The US score was positively correlated with ALT (r = 0.56) and AST (r = 0.47), and negatively correlated with the CD4 + /CD8 + ratio (r = −0.46) and NK cell activity (r = −0.38) (all P < 0.01). Conclusion These findings indicate that TAF not only suppresses viral replication and normalises liver enzymes but also promotes measurable structural liver improvement, as reflected by declining semi-quantitative US scores. The strong correlations of US scores with biochemical and immune parameters support its utility as a non-invasive imaging biomarker for monitoring treatment efficacy and hepatic repair.