What are the AASLD guidelines for the treatment of cirrhosis and hepatitis B (HBV) (Hep B)?

Updated: Aug 01, 2018
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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Answer

In adults with compensated cirrhosis and low levels of viremia (<2,000 IU/mL), regardless of ALT level, the AASLD suggests antiviral therapy (preferred: tenofovir, entecavir) to reduce the risk of decompensation. (Conditional recommendation).

Note the following:

  • If therapy is discontinued, closely monitor patients for a minimum of every 3 months for at least 1 year to detect early signs of viral rebound that may lead to decompensation.
  • In those not offered treatment, closely monitor every 3-6 months for an elevation in HBV DNA level and/or clinical decompensation; initiate treatment in these settings.
  • Patients with compensated cirrhosis and high HBV DNA levels (>2,000 U/mL) are treated according to the recommendations for HBeAg-positive and -negative immune-active chronic hepatitis B.

For HBsAg-positive adults with decompensated cirrhosis, the AASLD recommends indefinite antiviral therapy (preferred: entecavir, tenofovir) to reduce the risk of worsening liver-related complications, regardless of HBV DNA level, HBeAg status, or ALT level. (Strong recommendation) Also consider liver transplantation for eligible candidates.


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