Management of patients with decompensated HBV cirrhosis

Patients with decompensated hepatitis B virus (HBV) cirrhosis have a poor prognosis due to the development of progressive liver failure and hepatocellular carcinoma. Lamivudine appears to be a safe and effective antiviral agent, which may improve or stabilize liver disease in selected patients with advanced cirrhosis and active HBV replication. However, viral resistance can develop with prolonged treatment and some patients with advanced cirrhosis may not experience any discernible benefit. The use of hepatitis B immunoglobulin prophylaxis with or without lamivudine has resulted in excellent survival and a low rate of graft reinfection in patients who undergo liver transplantation for decompensated HBV cirrhosis. Adefovir and entecavir are newer antiviral agents that have activity against both wild-type and lamivudine-resistant HBV. Additional studies of individual or combination antiviral agents are urgently needed to improve further the prospects for the large number of patients worldwide with decompensated HBV cirrhosis.