Reply to: ‘Rethinking “inactive chronic hepatitis B”: should we treat patients with high HBsAg levels?’

Abstract

We appreciate the comments by Chen et al 1 on our recent publication entitled ‘Hepatitis B Surface Antigen Level Identifies Inactive Chronic Hepatitis B Patients from Asia with HCC Risk Below Surveillance Threshold’.2 Their comments highlight the heterogeneity among patients with inactive chronic hepatitis B (CHB) and raise an important clinical question: Should nucleos(t)ide analogue (NA) therapy be initiated in patients with inactive CHB with high hepatitis B surface antigen (HBsAg) levels? First, among the 58 patients with hepatocellular carcinoma (HCC) with baseline HBsAg >100 IU/mL, 27 (46.6%) had hepatitis B virus (HBV) DNA levels <200 IU/mL. Baseline HBV DNA levels were not associated with HCC development in patients with inactive CHB (table 2 of the original article). Given this, we questioned whether viral rebound, rather than baseline viral …