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Risk stratification in chronic hepatitis B patients for hepatocellular carcinoma surveillance: management in migrant sub-Saharan African populations
  1. Zillah Cargill1,
  2. Sarah E Brown1,
  3. Geoff Dusheiko1,2,
  4. Kosh Agarwal1
  1. 1 Institute of Liver Studies, King's College Hospital Liver Unit, London, UK
  2. 2 UCL Division of Medicine, London, UK
  1. Correspondence to Dr Zillah Cargill, Institute of Liver Studies, King's College Hospital Liver Unit, London SE5 9RS, UK; zillah.cargill{at}

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We read with interest the paper by Zeng et al,1 which provides a timely contribution to the ongoing debate on stratification and intensity of hepatocellular carcinoma (HCC) surveillance. The authors highlight the important need to identify patients with chronic hepatitis B (CHB) at high risk to prioritise HCC surveillance, not only during the waiting list disruption brought by the global COVID-19 pandemic, but also to improve surveillance strategies in the future and optimise patient uptake.

Surveillance for HCC is typically centred on a relatively imprecise clinical evidence base, reflected in the discrepancies observed between international guidelines. As these indices differ on how risk should be determined, there are significant implications for healthcare resources and the cost-effectiveness of CHB surveillance programmes. Thus, a large excess of hepatic imaging is undertaken, limiting the cost-effectiveness …

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  • Contributors ZC: drafting and editing of the manuscript. SB: drafting and review of the manuscript. GD and KA: critical review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ZC, SB and GD have no conflicts of interest to declare; KA has grant funding from Abbott, Gilead and MSD. He provides consultancy/speaker bureau for Assembly, Aligos, Arbutus, Gilead, Immunocore, Janssen, Roche, Sobi, Shinoigi and Vir.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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