Effectiveness of etiotropic therapy in achieving recompensation of cirrhosis

Objective: to provide an updated review of the effectiveness of etiotropic therapy in achieving recompensation in patients with liver cirrhosis associated with hepatitis B and C viruses (HBV, HCV) and alcohol-related liver disease. Key points. The conventional understanding of decompensated cirrhosis as an irreversible stage in its natural course is now being reconsidered. Emerging evidence suggests that eliminating the underlying etiological factor may promote structural and functional hepatic recovery, reduce portal hypertension and its associated complications, and lower the risk of hepatocellular carcinoma. Clinical improvement can also lead to better patient outcomes and, in some cases, allow for the removal of liver transplant candidates from waiting lists. To establish a standardized definition of cirrhosis recompensation, the Baveno VII Consensus Conference introduced specific criteria. These include: elimination of the primary etiological factor; resolution of ascites (without diuretics), hepatic encephalopathy (without lactulose or rifaximin), and the absence of recurrent variceal bleeding for at least 12 months; along with sustained improvement in liver function tests. Currently, the effectiveness of etiotropic therapy in meeting these criteria has been evaluated only in patients with decompensated cirrhosis due to alcohol-related liver disease and HBV/HCV infection. This is largely due to the limited understanding of the underlying causes of other chronic diffuse liver diseases. Conclusion. Research in this field is still in its early stages. Further studies are needed to clarify the pathophysiological mechanisms, modifying factors, predictors, and potential non-invasive biomarkers of cirrhosis recompensation.