Optimized Strategy of Switching to Tenofovir Alafenamide Fumarate Treatment for Nucleos(t)ide Analogue Experienced Patients with Chronic Hepatitis B

Xuan Hu¹Yin Kong²Yuanyuan Liu²Tianfu Liu²Aidi Ma²Yongfang Li²Yaping Zhang²Juan Li²Lingyi Zhang²Guangming Li^2*

• ¹Department of Gastroenterology, Anhui No 2 Provincial People's Hospital, Hefei, China
• ²Department of Hepatology, Lanzhou University Second Hospital, Lanzhou, China

Background: This study aimed to evaluate the efficacy and safety of tenofovir alafenamide fumarate (TAF) in nucleos(t)ide analogue (NA)-experienced patients with chronic hepatitis B (CHB) who exhibited partial virological response (PRT) or low-level viremia (LLV). Methods: This was a single-center, retrospective, real-world study. A total of 91 CHB patients with prior NA treatment and detectable HBV DNA after at least 48 weeks of therapy with entecavir (ETV) or other NA regimens were enrolled and subsequently switched to TAF. Among them, 24 patients had PRT (HBV DNA > 2000 IU/mL), and 67 patients had LLV (20 IU/mL < HBV DNA ≤2000 IU/mL). The dynamic changes in HBV DNA, HBsAg, HBeAg, ALT, and APRI were analyzed after switching to TAF. Results: The complete virological response rate (HBV DNA < 20 IU/mL) in the PRT group was 29.1% at week 24 and 75.0% at week 48; in the LLV group, it was 76.1% and 88.1%, respectively. Both groups showed a decline in HBeAg levels from baseline to weeks 24 and 48. In the PRT group, HBsAg levels decreased by 9.0% and 5.0% at weeks 24 and 48, respectively; in the LLV group, the reductions were 2.1% and 3.6%. The ALT normalization rate increased by 24.2% at week 48 compared with baseline. Additionally, eGFR levels improved after switching to TAF. No serious adverse events (SAEs) or deaths related to adverse events were observed. Conclusion: This real-world study suggests that switching to TAF is an effective and well-tolerated therapeutic strategy for NA-experienced CHB patients with PRT or LLV, offering a promising approach for treatment optimization.