Tenofovir for the treatment of adults with chronic HBV infection
- Anna SF Lok, MD
Anna SF Lok, MD
- Professor of Medicine
- University of Michigan Medical School
Tenofovir disoproxil fumarate and tenofovir alafenamide, like adefovir dipivoxil, are nucleotide reverse transcriptase inhibitors that have activity against hepatitis B virus (HBV) and HIV. These agents are approved for the treatment of HIV infection and have also received approval for treatment of chronic HBV.
This topic review will focus on treatment in patients infected with HBV alone. The use of tenofovir in patients coinfected with HBV and HIV is presented separately. (See "Treatment of chronic hepatitis B in the HIV-infected patient".)
Tenofovir is an acyclic nucleotide diester analog of adenosine monophosphate, which is administered orally as the prodrug tenofovir disoproxil fumarate (tenofovir DF) or tenofovir alafenamide (tenofovir AF). The intracellular, pharmacologically active moiety is tenofovir-diphosphate. Tenofovir DF has been used extensively for the treatment of HIV and chronic HBV infection. The newer formulation of tenofovir, tenofovir AF, is also effective for the treatment of HIV and HBV and has fewer adverse effects on renal function and bone density [1,2].
EFFECT ON VIROLOGIC OUTCOMES
A positive response to treatment is characterized by suppression of HBV DNA and loss of hepatitis B e antigen (HBeAg) (in patients who were initially HBeAg-positive). This is followed by loss of hepatitis B surface antigen (HBsAg) in some patients during the course of follow-up.
Tenofovir disoproxil fumarate — There is extensive experience demonstrating the virologic efficacy of tenofovir disoproxil fumarate (tenofovir DF) for the treatment of chronic HBV. Tenofovir DF is effective regardless of the patient’s HBeAg status, the presence or absence or cirrhosis, or prior use of nucleos(t)ide analogues.
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- Buti M, Gane E, Seto WK, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg-negative chronic hepatitis B virus infection: A randomised, double-blind, phase 3, non-inferiority trial. Lancet Gastroenterol Hepatol 2016; 1:196.
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- Lampertico P, Chan HL, Janssen HL, et al. Review article: long-term safety of nucleoside and nucleotide analogues in HBV-monoinfected patients. Aliment Pharmacol Ther 2016; 44:16.
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- Fontana RJ. Side effects of long-term oral antiviral therapy for hepatitis B. Hepatology 2009; 49:S185.
- EFFECT ON VIROLOGIC OUTCOMES
- Tenofovir disoproxil fumarate
- - Patients with HBeAg-positive chronic hepatitis B
- - Patients with HBeAg-negative chronic hepatitis B
- - Patients with previous exposure to other nucleos(t)ide analogues
- Lamivudine resistance
- Adefovir resistance
- - Patients with spontaneous exacerbation
- - In combination with other drugs
- Tenofovir alafenamide
- Regression of fibrosis and cirrhosis
- Reduced risk of hepatocellular carcinoma
- RISK OF RESISTANCE
- Renal insufficiency and renal tubular dysfunction
- Bone density
- SUMMARY AND RECOMMENDATIONS