Deciding on the Best Treatment in Patients With Various Types of Hepatitis B

Rowen K. Zetterman, MD


April 19, 2016

In This Article

Chronic Hepatitis B With Cirrhosis

Significant fibrosis may be identified in up to 20% of patients who have chronic hepatitis B and normal aminotransferase values.[36] The risk for eventual cirrhosis is greatest with continued or frequent elevation of aminotransferase values coupled with the continuous presence of circulating HBeAg.[16] Persons with circulating HBV DNA may be at greatest risk.[37]


The AASLD suggests that adults with compensated cirrhosis and low levels of viremia (< 2000 IU/mL) be treated with antiviral therapy to reduce the risk for decompensation, regardless of ALT level.[9] Treatment with nucleoside/nucleotide analogues is suggested.[38]

Hepatocellular Carcinoma

Factors associated with an increased risk for cirrhosis and hepatocellular carcinoma in chronic hepatitis B include older age, male sex, cirrhosis, elevated HBV DNA levels, presence of obesity or diabetes mellitus, a family history of hepatocellular carcinoma, consumption of alcoholic beverages, basal core promoter HBV mutation, cigarette smoking, aflatoxin exposure, and concurrent infection with either HCV or HIV.[39] Other associations with hepatocellular carcinoma risk include acquisition of HBV infection at an early age[40] and the continued presence of circulating HBeAg.[16] Patients with chronic HBV infection also may be at risk for pancreatic carcinoma.[41]

Although antivirals do not completely eliminate the risk for hepatocellular carcinoma in chronic hepatitis B, treatment with nucleoside/nucleotide analogues after initial curative treatment of hepatocellular carcinoma may reduce secondary recurrence.[42,43]


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