Treatment of Chronic Hepatitis B with Decompensated Cirrhosis (Variceal Hemorrhage)
Clinical Scenario
Decompensated Liver Cirrhosis
This protocol applies to HBsAg-positive patients who have developed decompensated cirrhosis — specifically those with variceal hemorrhage, ascites, hepatic encephalopathy, or hepatorenal syndrome — at any level of HBV DNA.
Why Cirrhosis Changes Management
Patients with decompensated cirrhosis due to chronic hepatitis B are recommended for antiviral treatment regardless of the level of HBV DNA or ALT. Additionally, all patients with decompensated cirrhosis require HCC surveillance and should be referred for consideration of liver transplantation.
Management involves indefinite oral antiviral therapy — the choice of agent and the decision to refer for transplantation evaluation are detailed in the full protocol.
The complete regimen, agent selection criteria, and monitoring approach are available in the structured protocol below.
References
DOI: 10.1097/HEP.0000000000001549
- Those with cirrhosis (compensated or decompensated) are recommended for antiviral treatment regardless of the level of HBV DNA or ALT.
- All require surveillance of HCC and those with decompensated cirrhosis should be referred for consideration of liver transplantation.
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