Department of Gastroenterology, Ren-Ai branch, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan.
Hepatitis B virus (HBV) infection is the major cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC) worldwide, especially in the Asia-Pacific region. Several hepatitis B viral factors predictive of clinical outcomes in HBV carriers have been identified. The REVEAL-HBV study from Taiwan illustrated the strong association between HBV DNA level at study entry and risk of HCC overtime. In this community-based cohort study, male gender, older age, high serum alanineaminotransferase (ALT) level, positive HBeAg, higher HBV DNA level, HBV genotype C infection and core promoter mutationare independently associated with a higher risk of HCC. Another large hospital-based ERADICATE-B cohort of Taiwanese patients further validated the findings of REVEAL-HBV. The risk of HCC started to increase when HBV DNA level was higher than 2000 IU/mL. Both HBV DNA and HBeAg levels were shown to be associated with HCC development. While HBV DNA level had better predictive accuracy than HBeAg level when investigating the overall cohort, in patients with HBV DNA level <2000 IU/mL, HBeAg level ≥1000 IU/mL was identified as a new independent risk factor for HCC. With the results from REVEAL-HBV, a risk calculation for predicting HCC in non-cirrhotic patients has been developed and validated by independent cohorts (REACH-B).Taken together, ample evidence indicates that HBeAg level can complement HBV DNA level in predicting HCC development, especially in HBV carriers with low viral load. In conclusion, HBV treatment guidelines should include the risk stratification of HCC to individualize the management of HBV carriers with different levels of HCC risk.