Safety and Effectiveness of Tenofovir Alafenamide in the Turkish Population: A Systematic Review

Hepatitis B virus infection is an important public health problem in the world and in Turkey. Nucleoside analogues and pegylated interferon-alpha are used as therapeutic agents in the management of chronic hepatitis B (CHB) infection. With current treatments, the disease is at a controllable point. Unfortunately, although cure studies continue, the cure treatments in the near future will not be an alternative. Tenofovir disoproxil fumarate (TDF) has been used for the treatment of CHB infection since 2008. Beside its high antiviral activity and lack of resistance, long-term use of TDF may lead to a decline in renal functions and bone mineral density. As a prodrug, tenofovir alafamide (TAF) provides considerable reduction (%90) in systemic exposure to tenofovir and has a better safety profile. TAF was used in some special cases (osteoporosis and decreased renal functions) in Turkey. In 2020, TAF was reimbursed for naive and treatment-experienced patients CHB patients. Evidence for the efficacy and safety of TAF continues to accumulate at an accelerating rate, especially following removal of reimbursement restrictions in 2020. In this review, we aim to summarize the real-world evidence obtained about TAF treatment in the last two years in Turkey.