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

ABSTRACT

Introduction: Hepatitis B virus (HBV) infection is the major cause of cirrhosis worldwide. The ultimate goal of current antiviral treatments for chronic hepatitis B (nucleos(t)ide analogs and interferon-α) is to prevent the development of end-stage liver diseases.

Areas covered: We present a review of the current literature on antiviral therapy in patients with chronic hepatitis B and cirrhosis. Medline search was performed to identify relevant literature from 1993 through January of 2017.

Expert commentary: One randomized controlled trial and a number of observational studies have shown that nucleos(t)ide analogs can decrease the incidence of hepatocellular carcinoma (HCC) in chronic hepatitis B patients with advanced fibrosis. Data from clinical trials of entecavir and tenofovir have shown that histological improvement and regression of fibrosis can be achieved in the majority of patients with chronic hepatitis B by successful viral suppression. Entecavir and tenofovir are the preferred antiviral agents for treatment of chronic hepatitis B in patients with cirrhosis due to their high antiviral potency and high genetic barrier to resistance. Pegylated interferon-α is another therapeutic option for chronic hepatitis B patients with well-compensated cirrhosis. However, interferon therapy is contraindicated in patients with decompensated cirrhosis, and evidence for reduced HCC is currently insufficient.

KEYWORDS:

• Hepatocellular carcinoma (HCC)
• entecavir
• fibrosis
• interferon-α
• nucleos(t)ide analogs
• tenofovir

Disclosure of interest

N Kawada has received research support from Bristol-Myers K.K., Gilead Sciences K.K., and Chugai Pharmaceutical Co., Ltd. MH Nguyen has received research support from the B.K. Kee Foundation, Asian Health Foundation, Janssen Pharmaceutical, Gilead Sciences and the National Cancer Institute (U.S.). MH Nyugen has acted as an advisor or consultant to Dynavax Laboratories, Intercept Pharmaceuticals, Gilead Sciences and Anylam Pharmaceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This manuscript was not funded.