Journal of Clinical Hepatology
This is a prospective cohort study on chronic hepatitis B (CHB) patients with low viremia (LLV) after treatment with entecavir (ETV). The study compared the efficacy and safety of sequential replacement with tenofovir disoproxil fumarate (TAF) and the combination of TAF on ETV. A total of 217 patients were enrolled, and after propensity score matching, 37 patients were in each group. The results showed that after 48 weeks of treatment, the HBV DNA negative conversion rate (86.49% vs 59.46%) and HBeAg negative conversion rate (59.46% vs 35.14%) in the combined group were significantly higher; liver fibrosis indicators (LSM), liver function (ALT/AST) improved more optimally, and platelet (PLT) levels increased more significantly; but creatinine (Cr) levels were higher than those in the sequential group, indicating that the latter had better renal protection. Both groups had a slight increase in total cholesterol (TC), and there were no differences in adverse reactions.
This study provides a key evidence-based basis for LLV, a common but easily overlooked "gray area" in clinical practice. Although LLV patients have low viral load (<2000 IU/mL), the progression of liver fibrosis, the risk of HCC, and the risk of drug resistance are still significantly higher than those with complete response. Previous studies have lacked high-quality comparative studies on optimized treatment plans for this population. This article systematically confirms for the first time that ETV + TAF combined therapy is superior to sequential monotherapy in terms of virological response and liver benefits, but renal safety needs to be weighed. The results directly support the recommendation in the "Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2022 Edition)" on "considering treatment adjustment for LLV patients" and suggest that individualized selection should be made in clinical practice - those with high fibrosis risk should prefer combination therapy, while those with baseline renal function decline should tend to sequential therapy.
Objective: To investigate the efficacy of sequential tenofovir alafenamide fumarate (TAF) therapy versus the regimen of entecavir...
