Tenofovir alafenamide significantly increased serum lipid levels compared with entecavir therapy in chronic hepatitis B virus patients

BACKGROUND Tenofovir alafenamide(TAF)has a serum lipid-raising effect in patients with HIV;however,its effect on serum lipids and nonalcoholic fatty liver disease(NAFLD)risk in patients with chronic hepatitis B(CHB)is unclear.AIM To compare the effects of TAF and entecavir(ETV)on serum lipid levels in patients with CHB.METHODS In this retrospective cohort study,the data including the clinical features,serum lipids,and metabolic factors of patients with CHB at baseline and approximately 1 year after TAF or ETV treatment were collected and analyzed.We used propensity score-matched models to assess the effects on high-density lipoprotein,lowdensity lipoprotein,triglycerides,and total cholesterol(TCHO).RESULTS A total of 336 patients(75.60%male)were included;63.69%received TAF and 36.31%received ETV.Compared with the ETV group,the TAF group had significantly higher TCHO levels after treatment(4.67±0.90 vs 4.36±1.05,P=0.006).In a propensity score-matched model for body mass index,age,sex,smoking,drinking,presence of comorbidities such as NAFLD,cirrhosis,diabetes mellitus,and hypertension,TAF-treated patients had significantly increased TCHO levels compared to that at baseline(P=0.019).There was no difference for the ETV group.Body mass index,sex,hypertension,baseline TCHO,and creatine kinase-MB isoenzyme levels were significantly associated with elevated TCHO levels in logistic regression analysis.However,1-year TAF treatment did not increase the incidence of NAFLD.CONCLUSION A greater increase in TCHO was observed in patients with CHB receiving TAF compared to those receiving ETV.However,TAF-induced dyslipidemia did not increase the incidence of NAFLD.

Effect of type 2 diabetic mellitus in the prognosis of acute-onchronic liver failure patients in China

BACKGROUND Acute-on-chronic liver failure(ACLF)patients have a high short-term mortality rate,and the severity evaluation of ACLF is necessary for prognostication.Therefore,it was meaningful to evaluate the association between type 2 diabetic mellitus(DM)and ACLF and further explore the feasibility of using DM as a prognostic indicator in ACLF patients.The association between type 2 DM and the prognosis of patients with severe liver disease remains unclear.AIM To examine the effect of type 2 DM on the prognosis of patients with ACLF.METHODS Clinical data from 222 ACLF patients were collected and analyzed.The patients were categorized into two groups depending on whether they had DM or not,and the clinical data of ACLF patients were measured within 48 h after admission.Complications of ACLF were documented during treatment,such as hepatic encephalopathy,hepatorenal syndrome,acute upper gastrointestinal hemorrhage,and spontaneous peritonitis(SBP).Values of laboratory parameters,complication rates,and hospital mortality rates were compared between two groups.RESULTS Among 222 ACLF patients,38 cases were categorized into DM groups,the mean age was 56.32 years and 73.68%were male.The prognosis of ACLF patients was significantly correlated with DM in univariate[hazard ratio(HR)=2.4,95%confidence interval(CI)=1.5-3.7,P<0.001]and multivariable analysis(HR=3.17,95%CI=1.82-5.523,P<0.001).The incident of SBP(34.21%vs 13.59%,P=0.038)and other infections like lung,urinary,blood,and cholecyst(44.74%vs 28.26%,P=0.046)were higher in DM patients than non-DM counterparts.In addition,the ACLF patients with DM tended to have a high mortality rate(P<0.001).Cumulative survival time was also significantly shorter in the ACLF patients with DM than non-DM.CONCLUSION A significant association between DM and the prognosis of ACLF patients was found in China.The ACLF patients with DM had higher incidence of hospital mortality and infection than those without DM.