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Tenofovir Disoproxil Fumarate Reduces the Severity of COVID-19 in Patients with Chronic Hepatitis B

Authors: Mateos-Muñoz B, Buti M, Vázquez IF, Conde MH, Bernal-Monterde V, Díaz-Fontenla F, Morillas RM, García-Buey L, Badía E, Miquel M, Amador-Navarrete A, Rodríguez-Tajes S, Ramos-Merino L, Madejón A, García-Retortillo M, Arenas JI, Cabezas J, Santiago JMG, Fernández-Rodríguez C, Cordero P, Diago M, Mancebo A, Pardo A, Rodríguez M, Hoyas E, Moreno JJ, Turnes J, Simón MÁ, Marcos-Fosch C, Calleja JL, Bañares R, Lens S, Garcia-Samaniego J, Crespo J, Romero-Gomez M, Gea F, de Santiago ER, Moreno S, Albillos A.

Dig Dis Sci. 2023 Feb 3:1-7. doi: 10.1007/s10620-022-07817-w. Online ahead of print.


Background and aims: HIV-positive patients on tenofovir hydroxyl fumarate (TDF)/emtricitabine have a lower risk of COVID-19 and hospitalization than those given other treatments. Our aim was to analyze the severity of COVID-19 in patients with chronic hepatitis B (CHB) on TDF or entecavir (ETV).

Methods: Spanish hospital databases (n = 28) including information regarding adult CHB patients on TDF or ETV for the period February 1st to November 30th 2020 were searched for COVID-19, defined as a positive SARS-CoV-2 polymerase chain reaction, and for severe COVID-19.

Results: Of 4736 patients, 117 had COVID-19 (2.5%), 67 on TDF and 50 on ETV. Compared to patients on TDF, those on ETV showed (p < 0.05) greater rates of obesity, diabetes, ischemic cardiopathy, and hypertension. COVID-19 incidence was similar in both groups (2.3 vs. 2.6%). Compared to TDF, patients on ETV more often (p < 0.01) had severe COVID-19 (36 vs. 6%), required intensive care unit (ICU) (10% vs. 0) or ventilatory support (20 vs. 3%), were hospitalized for longer (10.8 ± 19 vs. 3.1 ± 7 days) or died (10 vs. 1.5%, p = 0.08). In an IPTW propensity score analysis adjusted for age, sex, obesity, comorbidities, and fibrosis stage, TDF was associated with a sixfold reduction in severe COVID-19 risk (adjusted-IPTW-OR 0.17, 95%CI 0.04-0.67, p = 0.01).

Conclusion: Compared to ETV, TDF seems to play a protective role in CHB patients with SARS-CoV-2 whereby the risk of severe COVID-19 is lowered.

Keywords: COVID-19; Entecavir; Hepatitis B; Tenofovir.