Systematic review and meta-analysis: impact of anti-viral therapy on portal hypertensive complications in HBV patients with advanced chronic liver disease

Abstract

Background:The efficacy of treatment with nucleos(t)ide analogues (NAs) in non-cirrhotic chronic hepatitis B (CHB) patients is well-established. However, its impact on complications of portal hypertension in advanced chronic liver disease (ACLD) is less well-characterized.Methods: MEDLINE/PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, and abstracts of major international hepatology meetings were searched for publications from Jan 1, 1995 to Nov 30, 2021. Randomized control trials and observational studies reporting the efficacy of NAs in ACLD patients were eligible. Pooled risk ratios (RRs) for outcomes of interest were calculated with a random-effect or fixed-effect model, as propriate.Results: Thirty-nine studies including 14 212 ACLD patients were included. NA treatment was associated with reduced risks of overall hepatic decompensation events (RR, 0.51; 95% confidence interval [CI]: 0.37-0.71) such as variceal bleeding (RR, 0.44; 95% CI: 0.26-0.74) and also ascites (RR, 0.10; 95% CI: 0.01-1.59) on a trend-wise level. Moreover, the risks of hepatocellular carcinoma (HCC) (RR, 0.48; 95% CI: 0.30-0.75) and liver transplantation/death (RR, 0.36; 95% CI: 0.25-0.53) were also reduced by NA treatment and first-line NAs were superior to non-first-line NAs in regard to these outcomes (RR, 0.85; 95% CI: 0.75-0.97 and RR, 0.85; 95% CI: 0.73-0.99, respectively). Conclusion:NA therapy lowers the risk of portal hypertension-related complications including variceal bleeding, as well as HCC, and liver transplantation/death.

Comparable Mortality Between Asian Patients with Chronic Hepatitis B Under Long-Term Antiviral Therapy vs Matched Control: A Population-Based Study

“…Nonetheless, they found that long-term AVT significantly decreases the risk of hepatic decompensation. Similarly, further studies regarding the liver-related prognosis of patients with HBV-related LC with long-term AVT should be implemented to establish the management of the high-risk patients (35).…”

Outcome of untreated low-level viremia versus antiviral therapy-induced or spontaneous undetectable HBV-DNA in compensated cirrhosis

“…Patients with high serum HBV-DNA levels are at a higher risk of developing liver cirrhosis, hepatic decompensation, and HCC 1,2. Long-term AVT using entecavir or tenofovir disoproxil fumarate is regarded as the current mainstay of managing patients with chronic HBV infection 3–8. Nevertheless, as potent AVT cannot eradicate intrahepatic HBV, periodic surveillance to detect HCC at an early stage is still required 3,4,9–14…”

“…[1,2] Long-term AVT using entecavir or tenofovir disoproxil fumarate is regarded as the current mainstay of managing patients with chronic HBV infection. [3][4][5][6][7][8] Nevertheless, as potent AVT cannot eradicate intrahepatic HBV, periodic surveillance to detect HCC at an early stage is still required. [3,4,[9][10][11][12][13][14] To date, there are significant discrepancies among practice guidelines regarding the management of patients with compensated cirrhosis with LLV, defined as a serum HBV-DNA level of 20-2000 IU/mL.…”