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TDF Bone Loss HBV Switch — SCE Infectious Diseases MCQ

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HardHepatitisTDF Bone Loss HBV SwitchSCE Infectious Diseases

A patient with suppressed chronic hepatitis B develops progressive osteopenia during long-term tenofovir disoproxil fumarate therapy. Renal function is stable and adherence is excellent. What should be considered?

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Correct answer: D — Switch from TDF to TAF to reduce systemic tenofovir exposure

The best answer is “Switch from TDF to TAF to reduce systemic tenofovir exposure”. TAF achieves potent HBV suppression with lower systemic tenofovir exposure and less bone and renal toxicity; entecavir suitability depends on prior nucleoside exposure and resistance. Long-term nucleos(t)ide therapy is selected for viral suppression, resistance barrier, renal function and bone health; tenofovir alafenamide has less renal and bone exposure than TDF.

Reference: EASL clinical practice guidelines on hepatitis B: https://easl.eu/publication/management-of-hepatitis-b-virus-infection/