Antiviral Therapy in Hepatitis B Virus-Associated Liver Cirrhosis

Abstract

Background: Chronic hepatitis B virus (HBV) infection is a major risk factor for the development of liver cirrhosis and hepatocellular carcinoma (HCC). Key Messages: In patients with advanced liver fibrosis or liver cirrhosis, antiviral therapy is mandatory to slow down, halt or reverse disease progression and possibly reduce the risk of HCC development. As in patients without advanced fibrosis, PEG-interferon and nucleoside/nucleotide analogues (NUCs) are available for antiviral therapy. NUC therapy should be performed indefinitely as the rates of HBs-Ag loss are low. Entecavir or tenofovir should be preferred due to their strong antiviral potency and their high barrier to resistance. PEG-interferon therapy can be administered to patients with compensated liver disease but should not be offered to patients with signs of hepatic decompensation. Conclusions: Antiviral therapy in chronic HBV infection can reduce liver fibrosis and even revert overt cirrhosis. Whether it also reduces the risk of HCC development in cirrhotic patients remains elusive and might vary in different countries and ethnicities.

Retrospective analysis of hepatitis B virus chronic infection in 247 patients: clinical stages, response to treatment and poor prognostic factors

“…Seroconversion of HBsAg remains low globally. 4 , 18 About 10% of our patients had HBsAg seroconversion in this analysis, although only 3.1% did so with antiviral treatment.…”

“…Using lamivudine, a negative VL was observed in 56% at one year; however, globally, this rate was around 70%. 17 , 18 We could not assess patients’ adherence to treatment, and poor adhrence may have been responsible for lower therapeutic success.…”

“…The incidence of HCC remains high, even in large centers, and cirrhotic patients are at greater risk. 18 Male gender, viral coinfection, alcohol use, and high VL are also risk factors, 3 as well as HBeAg positive status. 19 , 25 …”

Antiviral therapy reduces rebleeding rate in patients with hepatitis B-related cirrhosis with acute variceal bleeding after endotherapy

“…Observing the 440 patients with HBV-related cirrhosis, Goyel et al [27] found that antiviral therapy significantly improved the Child score and patient’s overall clinical course. Long-term antiviral therapy could also reduce the incidence of HCC among patients with HBV-related cirrhosis [28, 29]. A few reports focused on the effects of antiviral therapy on variceal bleeding and its outcome [30, 31]; However, no research publication elucidated the effects of antiviral therapy on patients with HBV-related cirrhosis receiving endoscopic therapy after variceal bleeding.…”

Tenofovir veya Entekavir Tedavisi Alan Kronik Hepatit B Hastalarında Histolojik Yanıtların Değerlendirilmesi

“…Tedavi ile viral baskılama birlikte histolojik iyileşme de sağlayabilmektedir [4][5][6] . Yapılan çalışmalarda KHB hastalarında antiviral tedavi ile histolojik iyileşme görüldüğü belirlenmiştir [7][8][9][10][11][12] . Nükleoz(t)it analoğu olan tenofovir disoproksil fumarat (DF) ve entekavir ilk basamak tedavide önerilen yüksek genetik bariyere sahip oral antiviral ilaçlardır 5,6 .…”