Tenofovir alafenamid prophylaxis for the prevention of HBV reactivation in immunosuppressed subjects: a multicenter study

Abstract

Purpose: Reactivation of hepatitis B may be prevented by antiviral therapy in immunosuppressed high risk patients. Entecavir (ETC) and tenofovir disoproksil fumarat (TDF) have been used for a long time and recently introduced tenofovir alafenamid (TAF) seems to be a good alternative with rare side effects. This multicentered study with a large patient population aimed to investigate the effectiveness of tenofovir alafenamid (TAF) in immunsuppressed subjects. Materials and Methods: The records of six training and research hospitals between January 1, 2019 and September 30, 2021 were retrospectively reviewed, and patients who were started antiviral prophylaxis for hepatitis B and followed up for at least 6 months while under immunosuppressive therapy were included in the study. Risk groups were determined according to the immunosuppressive treatment or chemotherapy they received, as well as hepatitis B serology, and were examined in terms of the presence of hepatitis B reactivation and its side effects. Results: The mean age of patients was found as 62.5 +/- 29. Out of 148 patients, 85 (57.4%) received TAF, 63 (42.6%) received either Entecavir (ETC) or tenofovir disoproksil fumarat (TDF). The majority (83.1%) was found as HBsAg (-) antiHBc (+) and 16.9% was HBsAg (+). HBV DNA was traced in 36% of chronic HBV patients. Most of the patients (69.6%) were receiving immunospuppressives for treatment of a haematologic malignancy and 89.2% was in the high risk treatment group. There was no difference between TAF and the other drugs in terms of risks. Reactivation was not seen in any of the treatment groups. Conclusion: TAF is as effective as TDF and ETC when used for prophylaxis in immunosuppressed HBV patients. Side effects on kidney and bone are not seen in TAF treatment groups which will probably play a role in preferring this new drug.