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. The risk for eventual cirrhosis is greatest with continued or frequent elevation of aminotransferase values coupled with the continuous presence of circulating HBeAg. Persons with circulating HBV DNA may be at greatest risk.
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. Treatment with nucleoside/nucleotide analogues is suggested.
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. Other associations with hepatocellular carcinoma risk include acquisition of HBV infection at an early age and the continued presence of circulating HBeAg. Patients with chronic HBV infection also may be at risk for pancreatic carcinoma.
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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Cite this: Deciding on the Best Treatment in Patients With Various Types of Hepatitis B - Medscape - Apr 19, 2016.