Tenofovir disoproxil fumarate significantly decreases serum lipoprotein levels compared with entecavir nucleos(t)ide analogue therapy in chronic hepatitis B carriers

Summary Background Tenofovir disoproxil fumarate ( TDF ) and entecavir ( ETV ) are first‐line treatments for chronic hepatitis B ( CHB ). Studies suggest lipid lowering effect of TDF in human immunodeficiency virus positive ( HIV +) individuals, but the effect on lipids and cardiovascular disease ( CVD ) risk in CHB is unknown. Aim To compare TDF vs ETV effects on lipid levels in CHB . Methods In this retrospective cohort study, data on serum lipids and CVD risk factors at baseline and ~1 year on TDF or ETV were collected from CHB carriers. We used propensity score matched models to assess the effect on total cholesterol ( TC ), LDL ‐C, HDL and triglycerides ( TGL ). Results In 348 patients, median age was 57 ( IQR : 47‐65 years), 63% were male, 77% were Asian, 19% were cirrhotic, 25% were HB eAg positive at baseline, and 72% received TDF vs 28% ETV . ETV ‐treated patients were older (median age: 60 vs 55, P <.01), had similar smoking and hypertension rates, but diabetes and dyslipidemia were more prevalent (19% vs 9%, P =.01; 14% vs 6%, P =.05, respectively). In propensity score matched models for age, gender, usage of lipid lowering agents, dyslipidemia and diabetes, TDF ‐treated patients were more likely to show a 20% decrease in TC (95% CI : 3%‐25%), LDL ‐C (95% CI : 1%‐25%) and HDL ‐C ( CI : 10%‐30%) levels compared with those on ETV . No change in TGL was observed in either group. Conclusions A greater decline in TC , LDL ‐C and HDL was observed in CHB carriers receiving TDF compared with ETV . These data may influence anti‐viral choice in CHB carriers at risk for CVD .