Efficacy and safety of tenofovir alafenamide in HBeAg-positive and negative chronic hepatitis B patients aged over 30 years with normal ALT and detectable HBV DNA: a 96-week retrospective two-center study

Background: The 2022 update of Chinese Guidelines for Chronic Hepatitis B (CHB) Management advocates initiating antiviral therapy regardless of alanine aminotransferase (ALT) status in HBV DNA-positive patients aged > 30 years. This study aimed to investigate the virological response and renal safety profile of tenofovir alafenamide (TAF) in this specific population through both short-term (48-week) and extended (96-week) observations. Methods: In this multicenter retrospective cohort study, 122 treatment-naïve CHB patients meeting inclusion criteria from two tertiary hospitals (Yantai Qishan Hospital and Yantai Yuhuangding Hospital) underwent standard TAF monotherapy (25 mg/day). Serial assessments of virological parameters (HBV DNA quantification) and renal function markers (serum creatinine, estimated glomerular filtration rate) were conducted at baseline, week 48, and week 96. Intergroup comparisons showed no statistically significant differences, and all safety parameters exhibited no clinically relevant changes during the trial. Conclusion: This real-world evidence demonstrates durable antiviral efficacy of TAF in guideline-defined CHB patients aged > 30 years with normal ALT and active viremia, accompanied by favorable renal tolerability throughout the 96-week treatment period. Extended follow-up is ongoing to establish long-term clinical outcomes.