Wayne State University School of Medicine Detroit, MI, United States
Yechiel Mor, MD1, Jing Wang, MD1, Aliza Rizwan, MD2, Victoria Badia, 3, Paul Naylor, PhD3, Murray Ehrinpreis, MD3, Milton G. Mutchnick, MD, FACG3 1Wayne State University, Detroit Medical Center, Detroit, MI; 2Detroit Medical Center, Wayne State University, Detroit, MI; 3Wayne State University School of Medicine, Detroit, MI
Introduction: Tenofovir alafenamide (TAF) is less likely to be renal toxic as compared to tenofovir disoproxil fumarate (TDF) for therapy of chronic hepatitis B (HBV). This study evaluated the rate at which the TAF was substituted for TDF and the effect of TDF on renal function in our predominately African American (AA) population.
Methods: We identified retrospectively 199 HBV individuals without kidney disease (creatinine (Cr)< 2.5) with two Cr assessments at least 1 year apart. Pair wise analysis was used to evaluate the significance of an increase in Cr.
Results: There were 142 AA (73%), 39 from endemic regions (ie Asian/Middle Eastern (AME 20%)) and 14 Caucasians (Cau; 7%). AA were more likely to be coinfected with HIV (48%) vs AME (0%) and Cau (36%). Treatment rates for patients with only HBV infection were similar by race (21/72= 30% for AA, 10/39 = 26% for AME and 3/9= 33% for Cau). Co-infected HIV patients were treated for HBV by inclusion of anti-HBV agents in the HIV combination therapy protocols. With respect to treatment and kidney function, HBV TDF treated and HIV-HBV TDF treated patients were more likely to have a significant increase in Cr levels than non-treated HBV patients (Figure 1: Pairwise analysis plot of the increase in Cr in HBV patients). The increase due to TDF treatment is confounded, however by the fact that many of the non-treated Mono-HBV patients also had an increase in Cr. Most HIV-HBV infected patients were switched from TDF to TAF (AA 68/71= 95%; Cau 5/5=100%). The switch rate from TDF to TAF was lower for Mono-HBV AA (10/22= 45%) and Cau (2/4=50%) patients as compared to Asians (8/11= 72%) and HIV-HBV (73/76= 96%) patients. With respect to the reason for not switching to TAF, there were 8 (57%) with no discussion in the notes, 3 not returning after a 2018 visit and 2 having insurance related issues.
Discussion: While many HBV infected patients treated with TDF were likely to have a decline in kidney function (increase in Cr), many of the untreated HBV patients also had a decline. HIV-HBV patients were most likely to be switched from TDF to TAF as compared to Mono-HBV patients. Most importantly, the decline in kidney function of many non-treated HBV patients, suggest that evaluating kidney function for all HBV patients regardless of treatment is an important standard of care assessment in a primarily African American population-based clinic.
Figure: Change in Creatinine on x-axis plotted by mean of the sum. Statistical significance of the increase was defined using pair wise analysis.
Yechiel Mor indicated no relevant financial relationships.
Jing Wang indicated no relevant financial relationships.
Aliza Rizwan indicated no relevant financial relationships.
Victoria Badia indicated no relevant financial relationships.
Paul Naylor indicated no relevant financial relationships.
Murray Ehrinpreis indicated no relevant financial relationships.
Milton Mutchnick indicated no relevant financial relationships.
Yechiel Mor, MD1, Jing Wang, MD1, Aliza Rizwan, MD2, Victoria Badia, 3, Paul Naylor, PhD3, Murray Ehrinpreis, MD3, Milton G. Mutchnick, MD, FACG3. P1782 - Tenofovir Alafenamide vs Tenofovir Disoproxil Fumarate for the Treatment of Chronic Hepatitis B Virus Infection in the African American Community, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.