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Clearance of HBV markers and HCC risk: who is safe?
  1. Helmut M Diepolder
  1. Correspondence to Professor Dr Helmut Diepolder, Medical Department 1, Klinikum Kaufbeuren, Dr. Gutermannstr. 2, Kaufbeuren 87600, Germany; helmut.diepolder{at}kliniken-oal-kf.de

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Despite highly effective antiviral treatment options, chronic hepatitis B and its complications remain a medical challenge worldwide. Hepatocellular carcinoma (HCC) is still the fifth most common cause of cancer death in men and albeit surveillance programmes can principally reduce morbidity and mortality from HCC, the effect is modest and implementation of surveillance programmes is still inadequate.1 Depending on geographic region, hepatitis B is implicated as a cause of HCC in 5%–80% of patients. While antiviral therapy with interferon-α and nucleos(t)id analogues may stop disease progression in chronic hepatitis B, therapy is expensive, usually of long duration and not available in all parts of the world, particularly in many developing countries with a high prevalence of chronic hepatitis B. Moreover, depending on disease stage, a significant risk of HCC development may persist despite adequate viral suppression. Disappointingly, even in countries with high medical standards, implementation of treatment guidelines is far from complete.

Non-invasive and readily available markers for risk stratification are therefore of great importance to identify patients with the highest risk of HCC so that treatment and surveillance can be focused on those …

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