How long will it take to eliminate HCC risk in patients with chronic hepatitis B patients with potent antivirals?

Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) are currently the first-line oral antiviral agents for patients with chronic hepatitis B (CHB). They have high potency on viral suppression, a high genetic barrier to drug resistance mutations (1), and a good safety profile in long-term use (2-5). Thus, long-term therapy with ETV/TDF provides maintained viral suppression in CHB patients, improves liver histology, prevents fibrosis progression, liver-related complications and mortality (3,4,6,7). Despite a better clinical course, the risk of hepatocellular carcinoma (HCC) persists in CHB patients undergoing a long-term treatment (8,9). Currently, little data with large sample size and long follow-up duration are available on assessing the change in HCC incidence following long-term treatment and the corresponding risk factors on subsequent HCC development. The million-dollar question would be—if HCC can be eliminated one day if a CHB patient has been taking ETV/TDF for long enough.