After tracking the tenofovir alafenamide (TAF) data since its introduction, and the one-year follow-up results from San Francisco’s AASLD Liver Meeting reveal exactly what many of us hoped to see. The kidney and bone safety improvements are striking, though the efficacy remains comparable to TDF.
Trial Demographics and Design The pooled analysis combined two phase III trials – 425 HBeAg-negative and 873 HBeAg-positive patients across 17 countries. Demographics catch my eye: 80% Asian, average age 40, with 10% cirrhotic. The trials compared 25mg TAF to 300mg TDF daily, with half the participants switching to open-label TAF at week 96.
Viral Response Data The numbers tell an interesting story: 88% of TDF patients and 84% of TAF-switch patients achieved undetectable HBV DNA by week 144. ALT normalization hit 65% and 72% respectively. But cure rates remain frustratingly low – only 6-10% achieved HBeAg loss, with zero HBsAg clearance.
Kidney Function Improvements The kidney data is particularly compelling. I’ve seen similar patterns in my practice – eGFR improved in TAF-switch patients while remaining stable in TDF patients. The contrast in chronic kidney disease progression is stark: 4% worsening in TAF-switch versus 12% in TDF patients.
Bone Density Findings The bone mineral density improvements surprised even me – TAF-switch patients showed +0.98% hip and +2.04% spine increases from baseline. My older patients, especially post-menopausal women, could benefit significantly from these improvements.
Clinical Implications When starting patients on TAF now, I emphasize the long-term safety benefits while being realistic about viral clearance expectations. Consider switching patients with bone density concerns or declining kidney function from TDF to TAF – the safety improvements appear to justify the change, even with stable viral suppression.