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 are nucleotide reverse transcriptase inhibitors that are approved for the treatment of HIV infection and the treatment of chronic hepatitis B virus (HBV) infection. This topic will focus on the efficacy and safety of these agents in patients infected with HBV alone. Additional information on the use of tenofovir in the management of patients with chronic HBV infection (including those coinfected with HIV and HBV) is presented elsewhere. (See "Hepatitis B virus: Overview of management" and "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 (300 mg daily) has been used extensively for the treatment of HIV and chronic HBV infection. The newer formulation of tenofovir, tenofovir AF (25 mg daily), is also effective for the treatment of HIV and HBV and has fewer adverse effects on renal function and bone density [1,2]. (See 'Safety' below.)
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.
Patients with HBeAg-positive chronic hepatitis B — Tenofovir DF is effective for the treatment of chronic HBV in patients who are HBeAg-positive. However, patients in the immune-tolerant phase of infection (ie, a high viral load, and a normal alanine aminotransferase [ALT]) should generally not be treated because efficacy is lower in this setting. Indications for the treatment of chronic HBV are discussed elsewhere. (See "Hepatitis B virus: Overview of management", section on 'Indications for antiviral therapy'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- 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