Chronic hepatitis B in 2014: Great therapeutic progress, large diagnostic deficit

Table 4 Surveillance of hepatocellular carcinoma in subjects with chronic hepatitis B virus infection[3-5,31,255-266]

Surveillance all patients with cirrhosis and severe fibrosis

Including those treated with NUC

Surveillance in individuals with increased HCC risk, even without cirrhosis or severe fibrosis

High HBV-DNA

Males

Age > 40-50 yr (in particular in Asia and Africa)

Long duration of infection

Significant inflammation

Co-infection with HIV, HCV and HDV

Co-morbidities (e.g., diabetes mellitus, high alcohol consumption, NASH/NAFDL)

For surveillance: Ultrasound done every 6 mo by a skilled physician

Determination of AFP (in combination with ultrasound) still recommended by APASL[257], but not by EASL and AASLD guidelines[255-256]

AFP is less useful than ultrasound for surveillance of HCC

HCC: Hepatocellular cancer; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; HDV: Hepatitis D virus; AFP: Alpha fetal protein.