Long-Term Effects of Antivirals in Patients with HBV-Related Cirrhosis

Oral antivirals are considered to be safe and effective in hepatitis B virus (HBV) suppression and improvement in liver disease in patients with HBV-related decompensation; however, it is not known if this leads to avoidance or reduction in liver transplantation (LT) or what the long-term outcomes are in patients with decompensated cirrhosis.

A new prospective, multicenter, longitudinal study sought to assess the long-term effects of antiviral therapy in patients with HBV-related decompensated cirrhosis over seven years. The primary endpoint was five-year liver transplantation (LT)-free survival, with secondary endpoints including virologic/serologic response and improvement in liver function. Early mortality was defined as death occurring within six months after decompensation and virologic response as a maintained undetectable HBV DNA level (<400 IU/mL) during therapy.

A total of 707 patients with HBV genotype C and decompensated complications were included in the study, with 59.8% receiving antiviral therapy either as early treatment (within three months) or delayed treatment (postponed for over three months). Antivirals used included lamivudine, entecavir, adefovir, clevudine. and telbivudine. Virologic response after treatment was observed in 57.9% of patients, HBV drug resistance in 24.6%, and primary non-response in 3.1%; the remaining 14.4% were not eligible for response assessment due to early death, LT, or loss to follow-up after treatment initiation. Antiviral-treated patients had greater transplant-free five-year survival rates vs. untreated patients (59.7% vs. 46.0%, respectively). A significant improvement in liver function was observed in the treated patients, with 33.9% delisted for LT despite having poorer liver function and higher HBV replication activity at baseline vs. the untreated group. Early treatment was associated with improved clinical outcomes vs. those with delayed treatment and survival was significantly better in responders than in non-responders or untreated cases.

For patients with HBV-related decompensated cirrhosis, use of oral antivirals initiated early in treatment could have significant benefits in reducing the need for LT and improving long-term outcomes.

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