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JAC Advance Access originally published online on May 6, 2007
Journal of Antimicrobial Chemotherapy 2007 60(1):2-6; doi:10.1093/jac/dkm102
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Leading article

Optimal duration of therapy in HBV-related cirrhosis

Carmen Y. Lim and Kris V. Kowdley*

University of Washington Medical Center, Box 356174, 1959 NE Pacific Street, Seattle, WA 98195, USA

* Corresponding author. Tel: +1-206-598-2076; Fax: +1-206-598-3884; E-mail: kkowdley{at}u.washington.edu

It is estimated that one-third of the world's population has been exposed to hepatitis B virus and that 300–400 million people have chronic hepatitis B. In areas of the world where hepatitis B infection is endemic, this chronic viral infection is a major cause of premature morbidity and mortality related to hepatocellular carcinoma (HCC) and complications of end-stage liver disease. Recent data from population-based studies suggest that the level of viral replication in chronic hepatitis B is an independent predictor of the future complications of the disease; patients with hepatitis B viral DNA titres >104 copies/mL (especially those with titres >105 copies) have a significantly greater risk of developing HCC and cirrhosis. There is also recent evidence that treatment with antiviral therapy in patients with chronic hepatitis B who have advanced hepatic fibrosis is associated with a reduction in the risk of decompensation of liver disease and HCC. Several new antiviral medications have been recently approved for the treatment of chronic hepatitis B. Several recent position statements and practice guidelines have recommended treatment of patients with chronic hepatitis B with oral antiviral medications. However, there remains some disagreement as to the threshold of viral load before treatment should be initiated and the optimal duration of therapy in patients with cirrhosis due to hepatitis B. This article describes the current recommendations regarding therapy in this group of patients and suggests some criteria for treatment of patients with chronic hepatitis B-related cirrhosis or advanced hepatic fibrosis.

Keywords: hepatitis B virus , treatment , chronic HBV


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