This protocol covers patients with underlying liver cirrhosis who develop acute-on-chronic liver failure (ACLF) as a consequence of hepatitis B virus (HBV) reactivation — a high-acuity presentation that requires immediate, structured management.
Antiviral therapy is central and should be started as early as possible, alongside organ support and management of precipitating factors and associated complications in an appropriate level-of-care setting. The complete protocol — including the full decision algorithm, all interventions, and supporting measures — is available via the link below.
Administration of nucleoside analogues (tenofovir, entecavir) should be instituted as early as possible in patients with ACLF due to HBV infection (I;1).
At present, there is no specific therapy for ACLF aside from antiviral therapy in patients with ACLF due to reactivation of HBV infection. Treatment of ACLF should be based on organ support and management of precipitants and associated complications.
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