Published online Nov 6, 2018. doi: 10.12998/wjcc.v6.i13.671
Peer-review started: July 24, 2018
First decision: August 30, 2018
Revised: September 5, 2018
Accepted: October 12, 2018
Article in press: October 12, 2018
Published online: November 6, 2018
Processing time: 105 Days and 22.3 Hours
Tenofovir disoproxil fumarate (TDF) is a potent nucleotide analogue with high barrier to resistance, which is recommended for multi-drug resistant hepatitis B virus (HBV) infection. However, nephrotoxicity has been reported during TDF treatment, and tenofovir alafenamide (TAF), which has comparable efficacy to TDF and improves bone and renal safety, can be used as a replacement strategy. Herein, we describe a clinical case concerning a 60-year-old individual suffering liver cirrhosis and renal dysfunction, and being infected with multidrug-resistant HBV. When failing treatment with TDF, he received TAF as a rescue therapy. TAF effectively inhibited HBV replication without worsening renal function or serum phosphorus abnormality. Furthermore, hepatocellular carcinoma (HCC) occurred during TAF treatment despite controlling the viral load. The risk of HCC could not be eliminated and should be monitored during TAF treatment.
Core tip: Tenofovir alafenamide rescues multidrug resistance and renal dysfunction in an old patient but does not eliminate the risk of hepatocellular carcinoma (HCC) development. Despite controlling the viral load, risk of HCC exists and should be monitored in cirrhotic patients.