Bibliographic information
Recommendation
Treatment is recommended for all adolescents with chronic hepatitis B (CHB) (including pregnant women and girls and women of reproductive age) with: 1. Evidence of significant fibrosis (≥F2b) based on an APRI score of >0.5 or transient elastography value of >7 kPa or evidence of cirrhosis (F4) based on clinical criteria (or an APRI score of >1 or transient elastography value of >12.5 kPab), regardless of HBV DNA or ALT levels.
Recommended in favor
Strong
Certainty of evidence
Low
Notes and Remarks
Chronic hepatitis B (CHB): Defined as the presence of HBsAg on at least one occasion, and for adolescents and children, persistence of HBsAg for six months or more. The thresholds of non-invasive tests (APRI and transient elastography) for diagnosis of significant fibrosis or cirrhosis and treatment recommendation are based on extrapolating data from adults and have not yet been fully validated for adolescents or children. Clinical features of decompensated cirrhosis: portal hypertension (ascites, variceal haemorrhage and hepatic encephalopathy), coagulopathy or liver insufficiency (jaundice). Other clinical features of advanced liver disease and cirrhosis may include: hepatomegaly, splenomegaly, pruritus, fatigue, arthralgia, palmar erythema and oedema