She-Yan Wong, Xiangdong David Ren and Hie-Won Hann
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.