Hepatitis B virus-related decompensated liver cirrhosis: Benefits of antiviral therapy

Abstract

Following development of liver cirrhosis in patients with chronic hepatitis B, liver disease may continue to progress and decompensation or hepatocellular carcinoma (HCC) may occur, especially in those with active viral replication. Decompensation may manifest with jaundice, ascites, variceal bleeding or hepatic encephalopathy. Earlier studies have shown that the prognosis of decompensated cirrhosis is usually poor with a 5-year survival rate at 14-35% under conventional standard of care. The approval of oral antiviral agents has greatly improved the prognosis, as demonstrated in several cohort studies and randomized clinical trials involving therapy with lamivudine, adefovir dipivoxil, entecavir, telbivudine, or tenofovir disoproxil fumarate. Oral antiviral agents are effective in restoring liver function and improving survival in patients with decompensated cirrhosis especially if therapy is initiated early enough. These agents are generally well tolerated without significant side effects. However, their preventive effect in HCC development has yet to be convincingly demonstrated. Given their known resistance profiles, entecavir and tenofovir should be considered as the first-line therapy for patients with HBV-related decompensated cirrhosis.

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

“…1,56,57 These drugs can be safely used in any HBV infected patient and represent the only treatment option for several patient subgroups including those with decompensated liver disease, liver transplants, extrahepatic manifestations, acute hepatitis B or severe chronic HBV exacerbation. [57][58][59][60][61] NAs are also the only option for prevention of HBV reactivation in patients under immunosuppression. In addition, preventing HBV transmission in patients with high viremia who do not fulfill the typical criteria for treatment initiation represents further indications in which only NAs should be used.…”

Liver transplantation for hepatitis B virus: Decreasing indication and changing trends

“…However, the preventive effect of these agents against HCC development is less clear. Furthermore, the outcome of LT for HBV-related liver disease has dramatically changed since the introduction of oral antiviral agents and HBIG [15][16][17][18] . Here, we reported the rates and indications of HBVrelated LT in a Saudi population.…”

Treatment and Prognosis of Hepatitis B Virus Concomitant with Alcoholism

“…Several large population-based and international studies have reveal that antiviral therapy could reduce the incidence of hepatic failure, cirrhosis, HCC, and mortality in CHB patients without alcoholism [33][34][35][36][37][38][39][40].…”