The effect of tenofovir alafenamide fumarate on lipid profiles in pregnant women with hepatitis B virus.

PURPOSE: Tenofovir alafenamide fumarate (TAF) and tenofovir disoproxil fumarate (TDF) are usually used in pregnant women with hepatitis B virus (HBV), yet TAF has been associated with unfavorable lipid profiles in other HBV-infected groups. Data regarding the effects on the lipid profiles of pregnant women are scarce. This study compared the effects of TAF and TDF on lipid profiles in this population. METHODS: This retrospective study included 650 HBV-infected pregnant women, grouped into TAF and TDF cohorts based on the antiviral regimen. Generalized linear models were used to compare the effects of TAF and TDF on lipid levels, and causal mediation analysis was performed to assess whether the treatment difference in lipids was mediated by gestational weight gain. RESULTS: At delivery, the geometric mean ratios for total cholesterol (10.8%), low-density lipoprotein cholesterol (14.2%), and high-density lipoprotein cholesterol (10.0%) were elevated in the TAF group compared to the TDF group (all P < 0.001). An upward trend was also observed for triglycerides (6.3%; P = 0.062). The causal mediation analysis indicated that gestational weight change was not a significant mediator, accounting for less than 3.3%. Maternal and infant safety profiles were similar for most outcomes. CONCLUSION: TAF is effective in chronic HBV-infected pregnant women, but its lipid-elevating effect relative to TDF warrants clinical attention.