Rethinking the “Inactive” Carrier: A New Debate on Hepatitis B Treatment
A recent correspondence in Gut addresses a critical question in chronic hepatitis B (CHB) management: should patients classified as “inactive carriers” but with high levels of hepatitis B surface antigen (HBsAg) receive antiviral therapy? The discussion stems from a study showing that HBsAg levels can identify inactive CHB patients with a hepatocellular carcinoma (HCC) risk below typical surveillance thresholds. Notably, the authors highlight that nearly half of the HCC cases in their cohort with high HBsAg had undetectably low hepatitis B virus (HBV) DNA at baseline, challenging the sole reliance on viral load for risk stratification. This suggests that factors like HBsAg titer and potential viral rebound, rather than baseline DNA alone, may be more predictive of long-term liver cancer risk in this specific patient population.
Study Significance: This debate directly impacts clinical hepatology by questioning the traditional “watch-and-wait” approach for inactive CHB. For specialists managing viral hepatitis and cirrhosis, it underscores the need for more nuanced risk models that integrate HBsAg quantification. This could lead to revised treatment guidelines, potentially expanding the use of nucleos(t)ide analogues to prevent HCC in a subset of patients previously considered low-risk, thereby refining personalized strategies for hepatocellular carcinoma prevention.
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