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5?mg/dl) or reduced eGFR ( http://www.selleckchem.com/products/a-1155463.html histological improvement and reversal of fibrosis and cirrhosis after long-term treatment with both ETV and TDF [31]. A second liver biopsy evaluation after a median of 6?years in 57 patients under long-term ETV treatment showed a significant histological improvement (��1 point improvement in the Ishak fibrosis score) in 88% of patients, including all 10 patients with advanced fibrosis or cirrhosis at baseline http://www.selleck.cn/products/PD-0332991.html [32]. A reduction in the Ishak fibrosis score to 4 or less was observed in all four patients who had cirrhosis at baseline [33]. A more robust proof of the regression of cirrhosis was reported in NAs-na?ve patients treated with TDF enrolled in registration trials. Of the 96 patients with cirrhosis (Ishak score 5 or 6) at baseline, 71 (74%) had histologically reversed cirrhosis [34]. Clinical decompensation is fully prevented during 5?years of ETV or TDF therapy in patients with compensated cirrhosis as none developed ascites, hepatic encephalopathy, jaundice or gastrointestinal bleeding [6, 11, 34]. Survival was significantly improved by antiviral therapy in patients with decompensated liver disease, because persistent HBV DNA suppression led to reversal of clinical decompensation in most patients [13, 18]. In the VIRGIL study including 372 patients (274 without cirrhosis, 89 with compensated cirrhosis and 9 with decompensated liver disease) treated for 20?months with ETV, a virological response was associated with a lower probability of developing HCC, decompensated cirrhosis or death. However, the benefit of the virological response was only significant in patients with cirrhosis [35]. In Hong Kong, 1446 consecutive CHB patients (mean age 51?years, 33% with cirrhosis, 70% HBeAg-negative) who received ETV for a median of 36?months were http://www.selleckchem.com/products/cb-5083.html compared with a historical control cohort of 424 untreated patients. There was no difference in HCC, liver-related mortality and/or hepatic events defined as any liver-related complications (ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, variceal bleeding, hepatorenal syndrome) between the ETV and control cohort. Overall, the 5-year cumulative rates of HCC in ETV-treated patients and controls were similar (6.6% vs 6.5%, respectively), and were the same in the subgroup of patients without cirrhosis (3.3% vs 3.0%) but were significantly lower in ETV-treated patients with cirrhosis compared with untreated controls with cirrhosis (13.8% vs 26.4%).