title: Potent antiviral therapy improves survival in acute on chronic liver failure due to hepatitis B virus reactivation.
abstract: Acute on chronic liver failure (ACLF) is a disease entity with a high mortality rate. The acute event arises from drugs and toxins, viral infections, bacterial sepsis, interventions (both surgical and non-surgical) and vascular events on top of a known or occult chronic liver disease. ACLF secondary to reactivation of chronic hepatitis B virus is a distinct condition; the high mortality of which can be managed in the wake of new potent antiviral therapy. For example, lamivudine and entecavir use has shown definite short-term survival benefits, even though drug resistance is a concern in the former. The renoprotective effects of telbivudine have been shown in a few studies to be useful in the presence of renal dysfunction. Monotherapy with newer agents such as tenofovir and a combination of nucleos(t)ides is promising for improving survival in this special group of liver disease patients. This review describes the current status of potent antiviral therapy in patient with acute on chronic liver failure due to reactivation of chronic hepatitis B, thereby providing an algorithm in management of such patients.
authors.affiliation: Cyriac Abby Philips, Shiv Kumar Sarin, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
authors.forename: Cyriac Abby
authors.initials: CA
authors.lastname: Philips
authors.affiliation: Cyriac Abby Philips, Shiv Kumar Sarin, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology / Q000821:virology; D000818:Animals; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000472:pathogenicity; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents
keywords: Acute on chronic liver failure; Anti-viral therapy; Chronic hepatitis B infection; Flare of hepatitis B; Nucleoside analogue; Nucleotide analogue; Reactivation of hepatitis B