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In a randomized study of TDF versus placebo of 27 patients with severe CHB reactivation and ACLF [59], with a median baseline MELD of 25–27, TDF significantly reduced HBV-DNA levels, improved Child–Turcotte–Pugh and MELD scores, and reduced mortality, improving 3-month survival to 57% (8/14) from 15% (2/13) in those on placebo (P=0.03) (Table 5)