Antiviral therapy for hepatitis B virus‐related decompensated cirrhosis

Abstract

Antiviral therapy is important in patients with hepatitis B virus (HBV)-related decompensated cirrhosis. This therapy is beneficial in most patients for the stabilization or improvement of liver disease; however, advanced cirrhosis with a high Child-Pugh or model for end-stage liver disease (MELD) score may have progressed and does not benefit from antiviral therapy. It is important to identify patients with severe decompensated cirrhosis who will not improve under antiviral therapy and who require liver transplantation as early as possible. Entecavir (ETV) or tenofovir disoproxil fumarate (TDF) is the first-line therapy for nucleos(t)ide analogue (NA)-naive patients with decompensated cirrhosis due to their potent and prompt HBV suppressive effect and low rate of drug-resistant mutations. Patients on antiviral therapy should be monitored for virological and clinical response, compliance, drug resistance and adverse effects as well as surveillance for hepatocellular carcinoma (HCC). Additional studies of TDF and ETV are necessary to determine the optimal agent(s) for treating naive patients and those with drug-resistant decompensated cirrhosis. In order to evaluate the effectiveness of NA for the treatment of decompensated cirrhotic patients in the real world, high quality observational studies such as registration studies of antiviral therapy for HBV-related cirrhosis and a long-term follow-up in China, where a large number of such patients are found, are recommended.

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“…Currently, Interferons are considered the agents of choice, while nucleotidic/ nucleosidic analogues are used as second-line treatment. (9,10) In the United States alpha Interferon is recommended for children older than 3 years of age, while Lamivudin and Entecavir may be used in children at least 2 years of age. Tenofovir and Adefovir are approved for patients 12 years or older.…”

“…It is not recommended for patients with high bilirubin levels (above 3 mg/dL), low albumin (below 30 g/L), prolonged prothrombin time (above 3 sec) or hematological abnormalities (leukocytes below 4,000/mm 3 or thrombocytes below 150,000/mm 3 ). (10,12,16) Other relative or absolute contraindications include sever renal disease, cardiovascular conditions (including coronary disease), epilepsy or other central nervous system disorders, decom-pensated thyroid disease (especially hyperthyroidism), autoimmune conditions (including autoimmune hepatitis), immunosuppressive treatment, severe depression, anemia or presence of autoantibodies. (10,17) Most common side effects are flu-like ones (fever, myalgia, headache, etc.…”

“…(10,12,16) Other relative or absolute contraindications include sever renal disease, cardiovascular conditions (including coronary disease), epilepsy or other central nervous system disorders, decom-pensated thyroid disease (especially hyperthyroidism), autoimmune conditions (including autoimmune hepatitis), immunosuppressive treatment, severe depression, anemia or presence of autoantibodies. (10,17) Most common side effects are flu-like ones (fever, myalgia, headache, etc. ), but also neuropsychiatric disorders (depression, hetero and auto-aggressive behavior and suicidal conduct).…”