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.

Keywords: Acute on chronic liver failure; Chronic hepatitis B infection; Reactivation of hepatitis B; Flare of hepatitis B; Anti-viral therapy; Nucleoside analogue; Nucleotide analogue

Core tip: This topic highlight is an exhaustive review of acute on chronic liver failure (ACLF) secondary to reactivation of chronic hepatitis B virus (HBV) infection. It sheds light on current aspects of pathogenesis and definitions of reactivation of HBV and mechanisms of liver injury in acute on chronic liver failure in the wake of virus reactivation. The importance and effects of different nucleos(t)ide analogs in ACLF has been emphasized and an algorithm for management of this distinct condition has been provided.