Abstract
Approximately 350 million people worldwide are chronically infected with hepatitis B virus (HBV). If left untreated, approximately 20% will develop cirrhosis and complications of end-stage liver disease [1,2]. Antiviral therapy may decrease the progression to cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC). Until recently, the only treatment for chronic hepatitis B was standard interferon (IFN). Interferon has limited efficacy, and may be associated with severe sepsis and worsening of hepatic failure in patients with decompensated cirrhosis [3,4]. The availability of oral antiviral agents with a better safety profile has significantly changed the management of end-stage liver disease caused by HBV. Lamivudine has been shown to suppress HBV replication, and to improve or stabilize liver function in patients with compensated as well as in those with decompensated cirrhosis [5,6]. Adefovir dipivoxil has also demonstrated efficacy in patients with decompensated cirrhosis and lamivudine-resistant HBV [7]. Oral nucleos(t)ide agents have delayed or obviated the need for liver transplantation in some patients, but transplantation is still required for those who present with advanced liver failure [8,9]. This article will focus on the use of antiviral agents for the treatment of HBV-cirrhosis.
Published Version
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