EASL Clinical Practice Guidelines

Introduction

More than 360 million persons worldwide (6% of the world population) are chronically infected by the hepatitis B virus (HBV). Although the incidence of HBV infection has dramatically declined since the implementation of universal immunization programs in several countries and blood-donor screening, a significant number of children are still infected each year, often developing chronic infection and requiring appropriate follow-up [1]. Despite a rather benign course of chronic hepatitis B (CHB) during childhood and adolescence, 3–5% and 0.01–0.03% of chronic carriers develop cirrhosis or hepatocellular carcinoma (HCC), respectively, before adulthood [[2], [3]]. Such a risk for HCC rises to 9–24% when considering the whole lifetime, with an incidence of cirrhosis of 2–3% per year [[4], [5]]. Worldwide universal vaccination remains the goal for eliminating HBV infection and its complications. Treatment of CHB in childhood has been hampered by the chronic delay in licensing new drugs for pediatric use. Safe and effective antiviral therapies are available in adults, but few are labeled for the use in children, and an accurate selection of whom to treat and the identification of the right timing for treatment are needed to optimize response and reduce the risk of antiviral resistance. Although several guidelines on the management of adult patients with CHB have been published by major international societies, the clinical approach to infected children is still evolving, and is mostly based on consensus of expert opinion [[6], [7], [8], [9]].