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Managing patients with hepatitis-B-related or hepatitis-C-related decompensated cirrhosis

Nature Reviews Gastroenterology & Hepatology volume 8, pages 285–295 (2011)Cite this article

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Abstract

Treatment of patients with hepatitis-B-related or hepatitis-C-related decompensated cirrhosis should focus on controlling the complications of cirrhosis, surveillance for hepatocellular carcinoma and, if applicable, preparation for orthotopic liver transplant. Interferon-based regimens for the treatment of hepatitis C have been somewhat successful in patients with cirrhosis, although treatment of patients with decompensated cirrhosis should be approached with caution. Given the potential for exacerbation of decompensation and poor tolerance of adverse effects, treatment should be reserved for those patients awaiting liver transplantation. Eradication of HCV before liver transplantation reduces the chances of recurrent hepatitis C infection after transplant. HBV can be treated with few adverse effects in patients with decompensated cirrhosis. This treatment is associated with improvement in decompensation in some patients. Hepatocellular carcinoma remains a significant risk in all patients with cirrhosis, and control of or eradication of HBV or HCV does not remove this risk.

Key Points

  • Treating patients with hepatitis-B-related or hepatitis-C-related decompensated cirrhosis is challenging

  • Interferon-based regimens for the treatment of hepatitis C in patients with decompensated liver disease should be approached with caution

  • Eradication of HCV before liver transplantation can potentially prevent recurrence of HCV post-transplantation

  • Oral therapy for the treatment of hepatitis B in patients with decompensated cirrhosis is highly effective in suppressing HBV

  • Patients with hepatitis B who have a virologic response on oral therapies may experience an improvement in their decompensation after control of the virus

  • The risk of developing hepatocellular carcinoma is high for patients with hepatitis B or C and cirrhosis; surveillance should continue even if the virus is effectively controlled

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Figure 1: Treatment of patients with HBV-induced and HCV-induced cirrhosis.

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Acknowledgements

C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. New York-Presbyterian Hospital/Columbia University Medical Center, Center for Liver Disease and Transplantation, 622 West 168th Street, New York, 10032, NY, USA

    Scott A. Fink

  2. Weill Cornell Medical College, 1305 York Avenue, New York, 10021, NY, USA

    Ira M. Jacobson

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Both authors contributed equally to all aspects of this Review.

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Correspondence to Scott A. Fink.

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Fink, S., Jacobson, I. Managing patients with hepatitis-B-related or hepatitis-C-related decompensated cirrhosis. Nat Rev Gastroenterol Hepatol 8, 285–295 (2011). https://doi.org/10.1038/nrgastro.2011.57

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