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Tenofovir Alafenamide vs. Tenofovir Disoproxil Fumarate in Lowering the Risk of HCC Development in Patients With CHB

Seong Hee Kang1, Hyung Joon Yim1, Seul Ki Han2

  • 1Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.

Journal of Gastroenterology and Hepatology
|March 9, 2026
PubMed

Insights

Tenofovir alafenamide (TAF) significantly reduced hepatocellular carcinoma (HCC) risk compared to tenofovir disoproxil fumarate (TDF) in chronic hepatitis B (CHB) patients. This antiviral therapy comparison highlights TAF as a potentially safer option for preventing liver cancer.

Area of Science:

  • Hepatology
  • Virology
  • Oncology

Background:

  • Chronic hepatitis B (CHB) is a global health concern.
  • Tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) are first-line antiviral treatments for CHB.
  • Understanding their comparative risks for hepatocellular carcinoma (HCC) is crucial.

Purpose of the Study:

  • To compare the association of TAF versus TDF with the occurrence of HCC in treatment-naive CHB patients.
  • To evaluate the long-term safety and efficacy of these antiviral agents regarding HCC development.

Main Methods:

  • A multicenter cohort of 1364 treatment-naive CHB patients initiating TAF or TDF was analyzed.
  • Propensity score matching and inverse probability of treatment weighting were used to control for confounding factors.
  • HCC occurrence was monitored over a median follow-up period of 60 months.

Main Results:

  • In the propensity score-matched cohort (n=966), TAF use was associated with a significantly lower risk of HCC compared to TDF.
  • Crude incidence rates and 5-year cumulative risks for HCC were lower in the TAF group.
  • Multivariable and IPTW analyses consistently showed TAF was protective against HCC (aHR ~0.30).

Conclusions:

  • TAF use was associated with a substantial reduction in HCC hazard (approximately 71%) compared to TDF.
  • These findings suggest TAF may be a safer alternative for CHB management concerning HCC prevention.
  • Further research with larger cohorts and longer follow-up is recommended.
Abstract

Keywords:
chronic hepatitis Bhepatocellular carcinomatenofovir alafenamidetenofovir disoproxil fumarate

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