Metabolic effects and cardiovascular disease risks of TDF or TAF in patients with chronic hepatitis B: a systematic review and meta-analysis

Background and aimsThe effects of Tenofovir Disoproxil Fumarate (TDF) or Tenofovir Alafenamide (TAF) on lipid profiles have been observed in chronic hepatitis B (CHB) treatment. However, the metabolic features and their impact on cardiovascular risk remain unclear. We conducted a systematic review a...

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Main Authors: Yuan-Hai Zhou, Nan Cai, Yu-Xin Chen, Yong-Lu Su, Peng Hu
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-06-01
Series:Frontiers in Pharmacology
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Online Access:https://www.frontiersin.org/articles/10.3389/fphar.2025.1604972/full
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author Yuan-Hai Zhou
Yuan-Hai Zhou
Nan Cai
Nan Cai
Yu-Xin Chen
Yu-Xin Chen
Yong-Lu Su
Yong-Lu Su
Peng Hu
Peng Hu
Peng Hu
author_facet Yuan-Hai Zhou
Yuan-Hai Zhou
Nan Cai
Nan Cai
Yu-Xin Chen
Yu-Xin Chen
Yong-Lu Su
Yong-Lu Su
Peng Hu
Peng Hu
Peng Hu
author_sort Yuan-Hai Zhou
collection DOAJ
description Background and aimsThe effects of Tenofovir Disoproxil Fumarate (TDF) or Tenofovir Alafenamide (TAF) on lipid profiles have been observed in chronic hepatitis B (CHB) treatment. However, the metabolic features and their impact on cardiovascular risk remain unclear. We conducted a systematic review and meta-analysis to evaluate these effects.MethodsWe searched for studies from four major databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) that reported the effects of TDF or TAF on metabolism and cardiovascular disease risk. The changes in metabolic parameters and 10-year atherosclerotic cardiovascular disease (ASCVD) risk were compared with baseline in the TDF and TAF treatment groups. Extracted data were analyzed with the random-effects model or the fixed-effects model. Potential sources of heterogeneity were investigated using sensitivity and subgroup analyses.ResultsA total of 19 studies including 19,396 CHB patients (12,067 in TDF‐only group, 5,423 in TAF‐only group, and 1906 in TDF-switched group) were included in this meta-analysis. We found that both TAF and TDF treatment mildly increase the 10-year ASCVD risk. The TAF treatment showed significant increases in body weight, with no significant effects were observed on lipid levels or blood glucose. While TDF treatment has a lipid-lowering effect and caused weight loss. Subanalyses emphasized the impact of changing antiviral treatment strategies on metabolism. We found an increased risk of dyslipidemia and body weight gain after switching from TDF to TAF treatment.ConclusionAlthough TAF and TDF treatments exhibit different metabolic characteristics, both mildly increase the risk of cardiovascular disease.Clinical Trial Registrationidentifier CRD42024595452
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publishDate 2025-06-01
publisher Frontiers Media S.A.
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spelling doaj-art-af664e186f0c4eafb446dda949ca39ff2025-08-20T02:42:08ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-06-011610.3389/fphar.2025.16049721604972Metabolic effects and cardiovascular disease risks of TDF or TAF in patients with chronic hepatitis B: a systematic review and meta-analysisYuan-Hai Zhou0Yuan-Hai Zhou1Nan Cai2Nan Cai3Yu-Xin Chen4Yu-Xin Chen5Yong-Lu Su6Yong-Lu Su7Peng Hu8Peng Hu9Peng Hu10Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaInstitute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, Chongqing Medical University, Chongqing, ChinaInstitute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, Chongqing Medical University, Chongqing, ChinaDepartment of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaInstitute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, Chongqing Medical University, Chongqing, ChinaDepartment of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaInstitute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, Chongqing Medical University, Chongqing, ChinaDepartment of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaInstitute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, Chongqing Medical University, Chongqing, ChinaResearch Institute of Infectious Diseases and Parasitic Disease, Chongqing Key Laboratory of Infectious Diseases and Parasitic Disease, Chongqing, ChinaBackground and aimsThe effects of Tenofovir Disoproxil Fumarate (TDF) or Tenofovir Alafenamide (TAF) on lipid profiles have been observed in chronic hepatitis B (CHB) treatment. However, the metabolic features and their impact on cardiovascular risk remain unclear. We conducted a systematic review and meta-analysis to evaluate these effects.MethodsWe searched for studies from four major databases (PubMed, Web of Science, EMBASE, and the Cochrane Library) that reported the effects of TDF or TAF on metabolism and cardiovascular disease risk. The changes in metabolic parameters and 10-year atherosclerotic cardiovascular disease (ASCVD) risk were compared with baseline in the TDF and TAF treatment groups. Extracted data were analyzed with the random-effects model or the fixed-effects model. Potential sources of heterogeneity were investigated using sensitivity and subgroup analyses.ResultsA total of 19 studies including 19,396 CHB patients (12,067 in TDF‐only group, 5,423 in TAF‐only group, and 1906 in TDF-switched group) were included in this meta-analysis. We found that both TAF and TDF treatment mildly increase the 10-year ASCVD risk. The TAF treatment showed significant increases in body weight, with no significant effects were observed on lipid levels or blood glucose. While TDF treatment has a lipid-lowering effect and caused weight loss. Subanalyses emphasized the impact of changing antiviral treatment strategies on metabolism. We found an increased risk of dyslipidemia and body weight gain after switching from TDF to TAF treatment.ConclusionAlthough TAF and TDF treatments exhibit different metabolic characteristics, both mildly increase the risk of cardiovascular disease.Clinical Trial Registrationidentifier CRD42024595452https://www.frontiersin.org/articles/10.3389/fphar.2025.1604972/fulldyslipidemiametabolic profilecardiovascular risktenofovirdrug safetychronic hepatitis B
spellingShingle Yuan-Hai Zhou
Yuan-Hai Zhou
Nan Cai
Nan Cai
Yu-Xin Chen
Yu-Xin Chen
Yong-Lu Su
Yong-Lu Su
Peng Hu
Peng Hu
Peng Hu
Metabolic effects and cardiovascular disease risks of TDF or TAF in patients with chronic hepatitis B: a systematic review and meta-analysis
Frontiers in Pharmacology
dyslipidemia
metabolic profile
cardiovascular risk
tenofovir
drug safety
chronic hepatitis B
title Metabolic effects and cardiovascular disease risks of TDF or TAF in patients with chronic hepatitis B: a systematic review and meta-analysis
title_full Metabolic effects and cardiovascular disease risks of TDF or TAF in patients with chronic hepatitis B: a systematic review and meta-analysis
title_fullStr Metabolic effects and cardiovascular disease risks of TDF or TAF in patients with chronic hepatitis B: a systematic review and meta-analysis
title_full_unstemmed Metabolic effects and cardiovascular disease risks of TDF or TAF in patients with chronic hepatitis B: a systematic review and meta-analysis
title_short Metabolic effects and cardiovascular disease risks of TDF or TAF in patients with chronic hepatitis B: a systematic review and meta-analysis
title_sort metabolic effects and cardiovascular disease risks of tdf or taf in patients with chronic hepatitis b a systematic review and meta analysis
topic dyslipidemia
metabolic profile
cardiovascular risk
tenofovir
drug safety
chronic hepatitis B
url https://www.frontiersin.org/articles/10.3389/fphar.2025.1604972/full
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