Confused on whether to take treatment or not

D:A:D study: long-term treatment with tenofovir associated with increased risk of serious liver disease | aidsmap.
Read the article above and it confused me even more whether to start treatment or not.

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Hi Marlos1993,

I am interested in what @HealthExperts have to say about this article also. I don’t know if it is within a relevant context? Is this article about people who have AIDS and have increased risk if they have HBV or HCV? Or does this refer to people that just have HBV also?

What alarms me is that one part of the article states “The most common end-stage liver events were hepatic encephalopathy (43%) and variceal bleeding (27%).” I have already had or have both of those. However, I am in the cirrhosis stage, so I am assuming that makes a difference.

Lastly, is Vemlidy a d-type drug also? I started on TAF and have taken Entecavir and TDF and have been back on TAF for awhile. I didn’t see Vemlidy specifically mentioned in the article.

I am interested to see if and how this article pertains to us.


Thanks @Marlos1993 for bringing attention to this article. The important point here is that it is investigating HIV-positive individuals and not HBV-positive people. There are likely some different mechanisms by which HIV causes liver issues compared to HBV.

In HBV, there is overwhelming evidence show that antivirals (e.g. TDF, ETV, etc.) strongly reduce the risk of liver cancer and liver disease. This study in no way says that you should not take treatment to prevent liver disease in chronic hepatitis B infection.


Also, the rates of liver disease was very low in this population and the effect size that they show for TDF is also very low. This may represent a statistical anomaly and not something that is associated in real life. This study was done in 2016 and I am not aware of any other studies independently showing this since then.

I am so grateful that Thomas created this forum and is a very knowledgeable HBV scientist who can answer all these tough questions! It’s both illuminating and inspiring to me … thank you Thomas. Always, Joan