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Effects of antiviral therapy in patients with chronic hepatitis B and cirrhosis

Masako Okada1, Masaru Enomoto1, Norifumi Kawada1

  • 1a Department of Hepatology , Osaka City University Graduate School of Medicine , Osaka , Japan.

Expert Review of Gastroenterology & Hepatology
|July 29, 2017
PubMed

Insights

Nucleos(t)ide analogs effectively reduce liver disease progression and hepatocellular carcinoma (HCC) risk in chronic hepatitis B patients with cirrhosis. Entecavir and tenofovir are preferred for their potency and resistance profiles.

Area of Science:

  • Hepatology
  • Virology
  • Oncology

Background:

  • Hepatitis B virus (HBV) infection is a leading cause of cirrhosis globally.
  • Current antiviral therapies aim to prevent end-stage liver disease.
  • Chronic hepatitis B (CHB) management requires effective viral suppression.

Purpose of the Study:

  • To review current literature on antiviral therapy for CHB patients with cirrhosis.
  • To evaluate the efficacy of nucleos(t)ide analogs and interferon-α.
  • To assess the impact on liver disease progression and hepatocellular carcinoma (HCC) development.

Main Methods:

  • Comprehensive Medline literature search (1993-2017).
  • Analysis of randomized controlled trials and observational studies.
  • Review of clinical trial data for entecavir and tenofovir.

Main Results:

  • Nucleos(t)ide analogs decrease HCC incidence in CHB patients with advanced fibrosis.
  • Entecavir and tenofovir achieve histological improvement and fibrosis regression via viral suppression.
  • Pegylated interferon-α is an option for well-compensated cirrhosis, but contraindicated in decompensated cases.

Conclusions:

  • Entecavir and tenofovir are preferred antiviral agents for CHB patients with cirrhosis due to high potency and genetic barrier to resistance.
  • Successful viral suppression is key for histological improvement and fibrosis regression.
  • Further evidence is needed regarding interferon's role in HCC reduction.
Abstract

Keywords:
Hepatocellular carcinoma (HCC)entecavirfibrosisinterferon-αnucleos(t)ide analogstenofovir

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