Though the diagnostic sensitivity of APRI to identify liver fibrosis is relatively low (reported to be around 47% [18]), it is worth noting that this patient also harboured HBV mutations associated with severe liver disease including sW182* and BCP G1764T/C1766G, and presented with a HBeAg positive status and high viraemia; these are known independent risk factors for the development of liver cirrhosis and HCC [31, 32]. Here, OPN1SW is linked to hepatocellular carcinoma.