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World J Hepatol. Oct 8, 2015; 7(22): 2404-2410
Published online Oct 8, 2015. doi: 10.4254/wjh.v7.i22.2404
Benefits of nucleos(t)ide analog treatments for hepatitis B virus-related cirrhosis
Koichi Honda, Masataka Seike, Kazunari Murakami
Koichi Honda, Masataka Seike, Kazunari Murakami, Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu-City, Oita 879-5593, Japan
Author contributions: Honda K, Seike M and Murakami K designed the review aricle; Honda K wrote the manuscript; Seike M and Murakami K revised the manuscript.
Conflict-of-interest statement: We declare that we have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Koichi Honda, MD, PhD, Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita 879-5593, Japan. hondak@oita-u.ac.jp
Telephone: +81-97-5866193 Fax: +81-97-5866194
Received: April 27, 2015
Peer-review started: May 4, 2015
First decision: July 17, 2015
Revised: August 2, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: October 8, 2015
Abstract

Chronic hepatitis B infection induces progressive liver disease. Before nucleos(t)ide analogs (NUCs) became established as a safe and effective treatment for hepatitis B, it was difficult to suppress the activity of the hepatitis B virus (HBV). Currently, many patients with hepatitis or cirrhosis associated with HBV are treated with NUCs for an extended period of time, and the effects, benefits, and limitations of these treatments have been apparent. This article reviews HBV-related cirrhosis, its natural course and survival, histological improvement after NUC treatments, treatment effects for decompensated cirrhosis, the incidence of hepatocellular carcinoma (HCC) after NUC treatments, and the efficacy of NUC treatments before and after the treatment of patients for HBV-related HCC. Of particular interest are the histological improvements, including regression of fibrosis, that have been achieved with NUC treatments. Liver function of patients with decompensated cirrhosis has significantly improved regardless of the type of NUC applied, and treatment with NUCs has reduced the incidence of HCC in cirrhotic patients. However, cirrhosis remains the strongest risk factor for HCC occurrence following NUC treatments, and the long-term cumulative incidence of HCC after NUC treatments remains high. When recurrence does occur, it is important to reconsider the treatment modality according to the degree of improved liver function that was achieved.

Keywords: Hepatitis B, Nucleos(t)ide analogue, Liver cirrhosis, Lamivudine, Entecavir

Core tip: We presented the benefits of nucleos(t)ide analogs (NUCs) treatments for HBV-related cirrhosis in this article. NUC treatments have been found to improve inflammation and fibrosis in the liver of cirrhotic patients. Moreover, even in patients with decompensated cirrhosis, liver function has improved in many cases. Furthermore, although NUC treatments can reduce the incidence of hepatocellular carcinoma (HCC), rates of HCC remain high in patients with cirrhosis. NUC treatments have been found to improve liver function and the survival of patients with HCC. Improved liver function was also achieved by providing NUC treatments for hepatitis B virus-related HCC when recurrent tumors developed. Therefore, it is important to select the most appropriate treatment method considering the alterations in liver function that may occur following NUC treatments.