Review
Copyright ©The Author(s) 2015.
World J Gastroenterol. Feb 14, 2015; 21(6): 1738-1748
Published online Feb 14, 2015. doi: 10.3748/wjg.v21.i6.1738
Table 1 Studies of nucleos/tide analogs in patients with hepatitis B related decompensated cirrhosis (adapted by Cholongitas et al[88])
Ref.Number of patientsNA(s) used1-yr data
Prognostic factors for the outcome
↓ CTP score2, (%)MELD score ↑
Fontana et al[17]154LAMNRNRSerum bilirubin and creatinine levels at baseline
Schiff et al[18]226ADVNR-2NR
Shim et al[19]70ETV49-2.2NR
Liaw et al[20]45/45/22TDF/TDF + FTC/ETV26/48/42-2/-2/-2NR
Chan et al[21]114/114LdT/LAM32/39-1.0/-2.0NR
Hyun et al[22]45/41ETV/LAMNR/NR-4.9/-3.7Baseline CTP and MELD at 3 mo
Cholongitas et al[23]52ETV/TDF23.8/19.3-0.4/-2.2Changes in MELD score between baseline and 6 mo
Table 2 Dosage adjustment of nucleos(t)ides analogs in patients with chronic hepatitis B according to the creatinine (CrCl)[44]
CrCl (mL/min)LamivudineTelbivudineAdefovirEntecavir1Tenofovir
≥ 50100 mg/d600 mg/d10 mg/d0.5 mg/d245 mg/d
30-4950 mg/d600 mg/2nd day10 mg/2nd day0.25 mg/d245 mg/2nd day
10-2925 mg/d600 mg/3rd day10 mg/3rd day0.15 mg/d245 mg/3rd-4th day
< 5-10 or HD210 mg/d600 mg/3rd-4th day10 mg/wk0.5 mg/wk245 mg/wk3
Table 3 Management of chronic hepatitis B in special populations
Special populationManagement
Before and after liver transplantationBefore: entecavir or tenofovir (± telbivudine in the presence of renal dysfunction)
After: HBIG plus entecavir or tenofovir (consider telbivudine in the presence of renal dysfunction)
Before and after kidney transplantationBefore: entecavir or telbivudine or tenofovir (Figure 3)
After: entecavir or telbivudine or tenofovir in HBsAg(+) recipients [plus HBIG when HBsAg(-) recipients receive graft from HBsAg(+) donor with HBV viremia] (Figure 3)
Pregnancylamivudine, telbivudine or tenofovir in the last trimester of pregnancy when HBV DNA > 106 IU/mL
ChildrenInterferon or nucleos(t)ide analogue (check age of child)
Under immunosuppressive regimenHBsAg-positive candidates: lamivudine when baseline HBVDNA < 2000 IU/mL and short period (< 12 mo) of immunosuppression; otherwise: ETV or TDF
HBsAg-negative/anti-HBc positive candidates: (1) if baseline HBV-DNA detectable: as HBsAg-positive candidates; (2) otherwise: lamivudine only in hematological diseases or rituximab containing regimens