Antiviral Therapy in Decompensated Cirrhosis due to Hepatitis B Virus

Hepatitis B-related decompensated cirrhosis is a significant cause of morbidity and mortality. The development of specific antivirals improved the management of decompensated cirrhosis significantly over the past few years. Hepatitis B virus (HBV) replication is associated with a severe outcome in patients with HBV-related decompensated cirrhosis. Anti-HBV therapy has been found to be effective in preventing disease progression and extending the survival of decompensated patients. Early initiation of effective antiviral therapy should be offered to these patients because of the delay in the restoration of liver functions. Nucleos(t)ide analogues are effective, well tolerated and should be continued indefinitely. Highly potent and less resistance-prone drugs, including entecavir and tenofovir, are recommended for initial treatment. Lamivudine was widely used in China and early add-on therapy with adefovir allows us to rescue lamivudine resistance. Studies are ongoing with the newer generation of antivirals (telbivudine, tenofovir, entecavir, and emtricitabine) in monotherapy or in combination to find an optimal regimen. Despite efficient antiviral treatment, a biphasic survival pattern was observed, with most deaths occurring within the first 6 months of treatment. Model for End-stage Liver Disease and the Child-Turcotte-Pugh score may be applied to identify patients at risk for destabilization despite treatment to permit optimal utilization of the scarce organ resource. Patients having a high risk for death within 6 months should be transferred to liver transplantation center. The others may benefit from antiviral therapy with liver transplantation as an alternative. Copyright (C) 2011 S. Karger AG, Basel