IFN can cause acute exacerbation of hepatitis during treatment; particularly in patients with decompensated cirrhosis there is a risk of liver failure and serious infection, so IFN is contraindicated.[247, 248] There are reports of efficacy for IFN and Peg-IFN therapy of compensated cirrhosis similar to that for Endocrinology antagonist chronic hepatitis,[102, 221, 249] but consideration of maintenance of continuous HBV DNA negative conversion, and safety issues, makes entecavir the first choice treatment. By suppressing HBV replication, NAs inhibit progression of fibrosis and

progression of compensated cirrhosis to decompensated cirrhosis. In a randomized controlled clinical trial that randomly allocated lamivudine and a placebo to 651 patients with liver cirrhosis or advanced fibrosis, the proportion of patients with increased Child Pugh scores declined with lamivudine therapy (3.4% vs 8.8%), and the proportion of patients whose disease stage progressed also declined (7.8% vs 17.7%).[250] Long term continuous entecavir therapy ameliorates hepatic fibrosis, in 57% of all patients after 3 years of treatment, and in 85% of patients with advanced fibrosis, including liver cirrhosis.[18] With continuous treatment for an average of 6 years, hepatic

fibrosis improved in 88% of all patients, and in 100% of cases of patients with advanced fibrosis, including liver cirrhosis.[251] In other words, liver cirrhosis is not an irreversible condition, and with long term continuous entecavir therapy it is possible to ameliorate fibrosis. Relapse after cessation of NA http://www.selleckchem.com/products/bmn-673.html therapy presents a risk of liver

failure, so in general treatment continues for the rest of the patient’s life. Cessation of treatment can be considered in cases of HBsAg negative conversion, but no results are available concerning long term outcomes following cessation of NA therapy. Even in patients exhibiting histological improvement of fibrosis, or patients meeting the criteria for cessation of treatment in chronic hepatitis, the lack of clear data regarding the pros and cons of treatment cessation means it cannot be recommended. Recommendations Entecavir is the treatment of first choice for compensated cirrhosis. Endonuclease Long term continuous entecavir therapy ameliorates hepatic fibrosis, including liver cirrhosis. Relapse after cessation of NA therapy presents a risk of liver failure, so in general treatment continues for the rest of the patient’s life. The aim of treatment for decompensated cirrhosis is reversal of liver failure through improving hepatic function. Although several studies have reported improved hepatic function with lamivudine therapy,[249, 252-254] fewer studies have evaluated the therapeutic efficacy in patients with decompensated cirrhosis of entecavir, which is currently the treatment of first choice.