Treatment of Hepatitis B in Decompensated Liver Cirrhosis

Table 2

General Recommendations in Decompensated HBV Cirrhosis.

Assess disease severity	Clinical, liver biochemistry, creatinine, INR CTP score, MELD score
Prevent further liver damage	Avoid alcohol
	Avoid hepatotoxic drugs
	Avoid Immunosuppression. Antiviral prophylaxis if necessary
	Avoid Aspirin/NSAIDS
	Hepatitis A vaccination in nonimmune
Prevent and treat	Laboratory and clinical assessment 3 to 6 monthly
Complications	Endoscopy at presentation and treat varices accordingly
	Be aware of spontaneous infections and treat appropriately
	Salt and fluid restriction in ascites control, TIPS
	Albumin and terlipressin in hepatorenal syndrome
	Antibiotics and nonabsorbable disaccharides in hepatic encephalopathy
	Low-protein diet not essential
	Regular AFP measurement and ultrasound examination
Antiviral therapy	Entecavir
	Lamivudine. Replace with entecavir monotherapy, Tenofovir monotherapy, or add on adefovir in cases of lamivudine resistance
	Tenofovir
	Telbivudine
	Adefovir
Liver transplantation	Pretransplant antiviral therapy in viraemic subjects and immunoprophylaxis using HBIG after transplant