Abstract
The ultimate goal of antiviral treatment is prevention of hepatocellular carcinoma (HCC). Currently the end point of successful antiviral treatment for patients with chronic hepatitis B is to achieve HBsAg loss or HBsAg seroconversion. We report two patients who successfully developed anti-HBs with or without antiviral therapy and yet developed HCC. Initial commercial assay showed negative HBV DNA for both patients. However, they were found to have detectable HBV DNA by a new laboratory-developed HBV DNA assay. These cases show that patients with HBsAg seroclearance continue to be at risk for HCC and surveillance for HCC should be continued. The diagnosis of occult hepatitis B with an improved HBV DNA assays is also necessary as it is important for treatment for chronic HBV and prevention of HCC.
Highlights
The ultimate goal of antiviral treatment is prevention of hepatocellular carcinoma (HCC)
There are no guidelines for screening, but studies have shown that Occult hepatitis B (OHB) is likely a risk factor for cryptogenic HCC [3]
OHB has been shown in several studies to be associated with the development of HCC [3, 6]
Summary
The ultimate goal of antiviral treatment is prevention of hepatocellular carcinoma (HCC). At this time serum samples at the time of initial HCC diagnosis and at lung metastasis (both negative for HBV DNA by the commercial assay), and the excised liver tumor were retrospectively examined by the new laboratory developed assay (see Materials and Method). The patient has survived without further development of HCC or metastasis for the past 8 years and she has remained HBV DNA negative on lamivudine therapy She is currently HBsAg(-)/anti-HBs(+) and HBV DNA (-). Laboratory tests were routinely monitored and he remained well until an elevated AFP prompted an MRI that showed a 5 cm left lobe mass consistent with HCC His serum was undetectable for HBV DNA by the commercial PCR assay. Subsequent sera while on antiviral therapy were HBV DNA negative by the new HBV DNA assay
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