Michael R. CharltonAltaf AlamAkash ShuklaBekhbold DashtserenCosmas Rinaldi Adithya LesmanaDavadoorj DugerDiana Alcantara PayawalDo Duy CuongGanbolor JargalsaikhanIan Homer Yee CuaJose Decena SollanoKaram Romeo SinghKaushal MadanKhin Maung WinKhin Pyone KyiKyaw Soe TunMohd SalihMukul RastogiNeeraj SarafPham Thi Thu ThuyPham Tran Dieu HienRino Alvani GaniRosmawati MohamedTawesak TanwandeeTeerha PiratvisuthWattana SukeepaisarnjaroenWin NaingZahid Yasin HashmiMedanta Institute of Digestive &amp; Hepatobiliary SciencesFortis Healthcare Ltd.Yangon General HospitalMongolian National University of Medical SciencesUniversity of Santo Tomas HospitalBach Mai HospitalUniversity of Indonesia, RSUPN Dr. Cipto MangunkusumoThe University of ChicagoTaipei Medical UniversityKhon Kaen UniversityUniversity of Malaya Medical CentreFaculty of Medicine, Siriraj Hospital, Mahidol UniversityPrince of Songkla UniversityLokmanya Tilak Municipal Medical CollegeGI HepatologyMyanmar GI and Liver SocietyLiver FoundationLiver CenterUniversity of Medicine 1Max Smart Super Speciality HospitalCardinal Santos Medical CenterSt. Luke's Medical Center-Global CityQuaid-e-Azam International HospitalDHQ HospitalPham Ngoc Thach University of MedicineRegional Institute of Medical Science2020-08-252020-08-252020-01-01Journal of Gastroenterology. (2020)14355922094411742-s2.0-85087857583https://repository.li.mahidol.ac.th/handle/20.500.14594/58344© 2020, The Author(s). Asia has intermediate-to-high prevalence and high morbidity of hepatitis B virus (HBV) infection. The use of guideline-recommended nucleos(t)ide analogs with high barrier to resistance, such as entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF), is one of the key interventions for curbing HBV infection and associated morbidity in Asia. However, there are some challenges to the use of ETV and TDF; while ETV is associated with high resistance in lamivudine (LAM)-exposed (especially LAM-refractory) patients; bone and renal safety issues are a major concern with TDF. Hence, a panel of twenty-eight expert hepatologists from Asia convened, reviewed the literature, and developed the current expert opinion-based review article for the use of TAF in the resource-constrained settings in Asia. This article provides a comprehensive review of two large, phase 3, double-blind, randomized controlled trials of TAF versus TDF in HBeAg-negative (study 0108) and HBeAg-positive (study 0110) chronic HBV patients (> 70% Asians). These studies revealed as follows: (1) non-inferiority for the proportion of patients who had HBV DNA < 29 IU/mL; (2) significantly high rate of normalization of alanine aminotransferase levels; (3) no incidence of resistance; and (4) significantly better bone and renal safety, with TAF vs. TDF up to 144 weeks. Considering the benefits of TAF, the expert panel proposed recommendations for optimizing the use of TAF in Asia, along with guidance on specific patient groups at risk of renal or bone disease suitable for TAF therapy. The guidance provided in this article may help clinicians optimize the use of TAF in Asia.Mahidol UniversityMedicineReviewSCOPUS10.1007/s00535-020-01698-4