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World J Gastroenterol. Jun 21, 2014; 20(23): 7306-7311
Published online Jun 21, 2014. doi: 10.3748/wjg.v20.i23.7306
Does antiviral therapy reduce complications of cirrhosis?
Goh Eun Chung, Jeong-Hoon Lee, Yoon Jun Kim
Goh Eun Chung, Department of Internal Medicine, Healthcare Research Institute, Gangnam Healthcare Center, Seoul National University Hospital, Seoul 135-984, South Korea
Jeong-Hoon Lee, Yoon Jun Kim, Department of Internal Medicine and Liver Research Institute, Seoul National College of Medicine, Seoul 110-744, South Korea
Author contributions: Chung GE and Kim YJ designed the research; Chung GE and Lee JH performed the research; Chung GE and Kim YJ wrote the paper.
Correspondence to: Yoon Jun Kim, MD, PhD, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehang-no, Jongno-gu, Seoul 110-744, South Korea. yoonjun@snu.ac.kr
Telephone: +82-2-20723081 Fax: +82-2-7436701
Received: October 28, 2013
Revised: January 2, 2014
Accepted: April 1, 2014
Published online: June 21, 2014
Processing time: 236 Days and 3.5 Hours
Abstract

Chronic hepatitis B infection is associated with the development of cirrhosis, hepatocellular carcinoma, and finally liver-related mortality. Each year, approximately, 2%-5% of patients with hepatitis B virus (HBV)-related compensated cirrhosis develop decompensation, with additional clinical manifestations, such as ascites, jaundice, hepatic encephalopathy, and gastrointestinal bleeding. The outcome of decompensated HBV-related cirrhosis is poor, with a 5-year survival of 14%-35% compared to 84% in patients with compensated cirrhosis. Because the risk of disease progression is closely linked to a patient’s serum HBV DNA level, antiviral therapy may suppress viral replication, stabilize liver function and improve survival. This article briefly reviews the role that antiviral therapy plays in cirrhosis complications, particularly, in decompensation and acute-on-chronic liver failure.

Keywords: Antiviral therapy; Cirrhosis; Complication; Hepatitis B; Decompensation

Core tip: The goals of antiviral therapy in hepatitis B virus-related cirrhosis would be to improve the hepatic disease severity, improve the clinical symptoms and quality of life, and prolong patient’s survival. Despite the limitations, antiviral therapy with nucleos(t)ide in patients with HBV-related cirrhosis can prevent the development of complications from cirrhosis, particularly, decompensation and acute-on-chronic liver failure (ACLF). Early antiviral treatment is important for patients with severe decompensated cirrhosis and ACLF. Thus, physicians could treat these patients using lamivudine with careful monitoring for the development of resistance or using the most potent antiviral agent, such as entecavir or tenofovir.