Hepatocellular Carcinoma Still Occurs in Patients who Clear HBsAg

Briefly noted:

Editorial: MH Nathanson, N Terrault Hepatology 2016; 64: 328-29. This very unusual editorial explains a published erratum of 2010 paper reversing a claim that patients with Hepatitis B who had achieved HBsAg clearance had markedly decreased rates of hepatocellular carcinoma (37 cases per 100,000 person-years). After correction of the arithmetic error, the rate of HCC in this population was actually 442 cases per 100,000 person-years.  The editorial does reiterate that studies have shown lower HCC among those with low HBV DNA which is a prerequisite for HBsAg clearance. Exact risk is difficult in this population due to infrequent development of HBsAg loss and infrequent development of HCC.  The message: While loss of HBsAg may lower HCC risk, there remains a need for HCC surveillance.

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