Chronic Hepatitis B is a long-term liver disease. The disease is often characterized by
abnormal levels of serum ALT and AST, as well as liver histology, and is transmitted through
blood, sexual contact, and mother-to-child transmission.
The symptoms of CHB include fatigue, nausea, abdominal distension, and Rt hypochondrial pain,
and in severe cases, it can be accompanied by chronic liver disease, spider nevus, abnormal
liver function, or persistent abnormality. The progression of hepatitis B virus (HBV) is
closely linked to its replication, and the most effective way to prevent it is through
hepatitis B vaccination. However, there is currently no specific drug available to eliminate
the virus in patients with chronic hepatitis B (CHB) due to the low rate of HBsAg clearance.
Instead, primary treatment methods for CHB aim to inhibit virus replication for an extended
period and delay the onset of liver cirrhosis and hepatocellular carcinoma. Antiviral, liver
protection, antifibrosis, and immunomodulatory therapies are used to achieve this goal. Among
these therapies, nucleoside (acid) analogs (NA) are commonly used, with drugs such as
entecavir (ETV) and tenofovir (TDF) being the most effective. Tenofovir is a new type of
nucleotide reverse transcriptase inhibitor, which inhibits reverse transcriptase similarly to
nucleoside reverse transcriptase inhibitors. To a certain extent, it can reduce transaminase,
protect the liver, and has a good effect on the treatment of hepatitis B. ETV is a carboxylic
analog of 2'-deoxyguanosine, which inhibits HBV DNA polymerase by competing with natural
deoxy guanosine triphosphate.
The use of entecavir (ETV) and tenofovir disoproxil (TDF) are both effective in managing
hepatitis B virus (HBV) infection, and are well-tolerated by most patients.
While there are no significant differences in the ability of the various treatments to
suppress the virus, some studies suggest that TDF may achieve biochemical response more
quickly. Nucleoside analogs with a high barrier to resistance are unlikely to lead to the
clearance of hepatitis B surface antigen, and should therefore be continued for most patients
throughout their lifetime. However, there are concerns about the potential for toxicity with
TDF in patients who have additional risk factors for kidney and bone problems. It is
important to monitor for adverse effects, and switching to ETV may be a safe and effective
alternative for patients with HBV. Although effective antiviral treatment can improve the
clinical outcome of chronic HBV patients, there is still a risk of developing hepatocellular
carcinoma (HCC) even with viral suppression. It is unclear whether TDF-based regimens offer
any additional benefits over ETV in preventing HCC, and more research is needed in this area.
Studies conducted on both TDF and ETV have demonstrated their safety in both pivotal trials
and real-life cohorts. In less than 10% of cases, mild side effects such as headache,
fatigue, dizziness, nausea, abdominal discomfort, and nasopharyngitis have been reported for
both drugs. These side effects are generally temporary and not severe enough to require
discontinuation of treatment. However, TDF has been associated with kidney dysfunction,
particularly in patients with pre-existing kidney disease or other risk factors for renal
impairment. Furthermore, TDF has been linked to bone disease. As a result, the European
Association for the Study of the Liver recommends selecting or switching to ETV for patients
with chronic hepatitis B who are at greater risk of bone and kidney toxicity.