Management of HBV and HBV/HDV-Associated Liver Cirrhosis

Abstract

Background: Chronic hepatitis B virus (HBV) infection and hepatitis delta virus (HDV) co-infection lead to liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). Methods: We review the current knowledge of the management of HBV mono-infection and HBV/HDV co-infection with a special emphasis on liver cirrhosis. Results: Treatment options for chronic hepatitis B are pegylated interferon (PEG-IFN) alfa and nucleos(t)ide analogues (NUC). PEG-IFN is a finite option to achieve hepatitis B surface antigen loss in compensated cirrhosis. However, this goal is rare. NUC are potent to achieve HBV DNA suppression but long-term treatment is mandatory in most cases. Long-term treatment with NUC can lead to reversion of liver cirrhosis, improve liver function, prevent liver transplantation, and reduces but does not eliminate the risk for development of HCC. Treatment options for hepatitis D are limited to PEG-IFN. Although late relapse is common, treatment with PEG-IFN reduces disease progression. However, new treatments are urgently needed for HDV infection. Conclusion: Early treatment of chronic hepatitis B and D is important to prevent complications of cirrhosis. HCC surveillance remains important in patients with cirrhosis.

Acquired hepatocerebral degeneration in a patient with hepatitis B and hepatitis delta virus coinfection

“…The literature shows that in adult carriers of HBsAg who are coinfected with HDV, the period of progression to chronicity is 2-6 years, whereas in children, chronicity occurs more quickly. HDV also has a remarkable ability to dominate and suppress other viral agents (such as HBV and HCV), especially in patients with chronic hepatitis and cirrhosis 2 , as shown in the case presented. The pathogenesis of ADH has not yet been clearly elucidated.…”

“…In the Brazilian Amazon region, 41.9% of HBV surface antigen (HBsAg) positive individuals are HDV coinfected 1 . HBV/HDV coinfection accelerates progression to chronic liver disease, cirrhosis, and hepatocellular carcinoma 2 . Advanced liver disease frequently causes neurological manifestations, including hepatic encephalopathy, hepatic myelopathy, and acquired hepatocerebral degeneration (AHD) 3 .…”

Management of individuals with chronic hepatitis B virus infection and persistent normal or mildly elevated aminotransferase levels

“…8,9 However, several such reports indicate normal ALT level in patients with severe pathological fibrosis or apparent inflammation, even in patients with the decompensated cirrhosis, or end stage of liver disease. [14][15][16][17] The noninvasive techniques of hepatic fibrosis evaluation have been popular in the clinic but are far from optimal. [14][15][16][17] The noninvasive techniques of hepatic fibrosis evaluation have been popular in the clinic but are far from optimal.…”

Challenges in warranting access to prophylaxis and therapy for hepatitis B virus infection

“…11 NAarepotentinhibitorsofreplicationandafter5-6years of treatment HBV DNA levels are below the limit of detection in almostallpatients.Also,effectiveNAtreatment isassociatedwith theregressionoffibrosisandthereductionofHCC. 13 However,the ultimategoal,HBsAgclearance,thesurrogateforaclinicalcure,is rare and thus life-long treatment is necessary in most patients. 14 It is also important to note that NA therapy is safe for long-term administration, thus, side effects do not prevent extensive use.…”