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    A global consensus on the critical care management of acute‑on‑chronic liver failure patients: The APASL ACLF beijing position paper
    (Springer Nature Link, 2026) Chen, Tao; Choudhury, Ashok; Liu, Wei; Zhang, Meng; Wu, Wenhui; Xiang, Huiling; Wang, Xiaojing; Abbas, Zaigham; Örmeci, Necati; Ning, Qin
    Background and aims Acute-on-chronic liver failure (ACLF) is a severe syndrome in patients with chronic liver disease, marked by rapid multi-organ failure and high short-term mortality. Managing ACLF requires intensive care, but standard ized global guidelines were previously lacking. The APASL ACLF Research Consortium (AARC) developed this position paper to establish a unified, evidence-based consensus for its critical care management. Methods A global collaboration of 109 experts employed a systematic methodology to address key aspects of ACLF care. Sections were drafted by specialist teams, with recommendations developed using the GRADE system. Draft statements underwent iterative review and refinement, followed by an expert panel consensus process consisting of open show-of-hands voting during the APASL Annual Conference in March 2025 in Beijing and a subsequent anonymous online voting round. Results The consensus delivers 104 position statements. Key recommendations include using prognostic scores (AARC, CLIF-C ACLF, GIC) for ICU transfer and treatment decisions, and aggressively managing precipitating factors or complica tions like infections. It details organ-specific support for liver, kidney, and brain failure, advocating for early, targeted antibi otics and careful fluid management. The role of bridging therapies (plasma exchange, artificial liver systems) and nutritional support is emphasized. For transplantation, the guidelines provide criteria for patient selection and timing, particularly for alcohol-related ACLF. Conclusions The APASL ACLF Beijing Position Paper provides a comprehensive, standardized framework for managing critically sick ACLF patients. Integrating multidisciplinary expertise and current evidence, these guidelines aim to optimize care, inform clinical decisions, and improve survival for this high-risk population. As a few recommendations are supported predominantly by data from different continents, they should therefore be interpreted in local contexts.
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    Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study
    (Elsevier, 2023) Razavi-Shearer, Devin; Gamkrelidze, Ivane; Pan, Calvin; Jia, Jidong; Berg, Thomas; Gray, Richard; Lim, Young-Suk; Chen, Chien-Jen; Ocama, Ponsiano; Mekonnen, Hailemichael; Abbas, Zaigham; Abdallah, Ayat; Örmeci, Necati; Razavi, Homie
    Background The 2016 World Health Assembly endorsed the elimination of hepatitis B virus (HBV) infection as a public health threat by 2030; existing therapies and prophylaxis measures make such elimination feasible, even in the absence of a virological cure. We aimed to estimate the national, regional, and global prevalence of HBV in the general population and among children aged 5 years and younger, as well as the rates of diagnosis, treatment, prophylaxis, and the future burden globally. Methods In this modelling study, we used a Delphi process with data from literature reviews and interviews with country experts to quantify the prevalence, diagnosis, treatment, and prevention measures for HBV infection. The PRoGReSs Model, a dynamic Markov model, was used to estimate the country, regional, and global prevalence of HBV infection in 2022, and the effects of treatment and prevention on disease burden. The future incidence of morbidity and mortality in the absence of additional interventions was also estimated at the global level. Findings We developed models for 170 countries which resulted in an estimated global prevalence of HBV infection in 2022 of 3·2% (95% uncertainty interval 2·7–4·0), corresponding to 257·5 million (216·6–316·4) individuals positive for HBsAg. Of these individuals, 36·0 million were diagnosed, and only 6·8 million of the estimated 83·3 million eligible for treatment were on treatment. The prevalence among children aged 5 years or younger was estimated to be 0·7% (0·6–1·0), corresponding to 5·6 million (4·5–7·8) children with HBV infection. Based on the most recent data, 85% of infants received three-dose HBV vaccination before 1 year of age, 46% had received a timely birth dose of vaccine, and 14% received hepatitis B immunoglobulin along with the full vaccination regimen. 3% of mothers with a high HBV viral load received antiviral treatment to reduce mother-to-child transmission. Interpretation As 2030 approaches, the elimination targets remain out of reach for many countries under the current frameworks. Although prevention measures have had the most success, there is a need to increase these efforts and to increase diagnosis and treatment to work towards the elimination goals.
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    The worldwide medical impact of hepatitis D virus infection: Focus to Central Asia
    (Academic Press, 2025) Aghayeva, Gulnara; Rizzetto, Mario; Örmeci, Necati; Turcanu, Adela; Abbas, Zaigham; Bedewy, Essam; Satapathy, Sanjaya K.; Al-Mahtab, Mamun; Singh, Shivaram Prasad; Akbar, Sheikh Mohammad Fazle; Ala, Aftab; Schiano, Thomas D.
    Hepatitis D virus (HDV) requires hepatitis B virus (HBV) for its replication. Concurrent infection with HBV and HDV results in more severe disease outcomes than infection with HBV alone, inducing cirrhosis, fulminant hepatitis, and hepatocellular carcinoma, and representing a significant cause of global mortality. Central Asia remains an area of high HDV prevalence but local features of the infection were poorly detailed in the past. Until recently, interferon has represented the only treatment option in patients with chronic hepatitis D; however, it is associated with low efficacy and a high burden of side effects. The discovery of the entry inhibitor bulevirtide has represented a breakthrough in HDV treatment. Other compounds (i.e., lonafarnib, new anti-hepatitis B virus drugs) are under development to provide alternative or combined strategies for HDV cure.