P1782 - Tenofovir Alafenamide vs Tenofovir Disoproxil Fumarate for the Treatment of Chronic Hepatitis B Virus Infection in the African American Community

Yechiel Mor, MD¹, Jing Wang, MD¹, Aliza Rizwan, MD², Victoria Badia, ³, Paul Naylor, PhD³, Murray Ehrinpreis, MD³, Milton G. Mutchnick, MD, FACG^3
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.



Disclosures:


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.