We read with great interest the recent article by Choi et al.1 By analysing the data of a multicentre historical cohort including 4693 adult patients with chronic hepatitis B (CHB), they concluded that patients with moderate baseline viral loads, particularly around 6 log10 IU/mL, demonstrated the highest on-treatment hepatocellular carcinoma (HCC) risk. Because this conclusion is interesting and different from the findings of some previous studies,2 3 which may affect the timing of treatment initiation for many patients with CHB, findings of this study should be cautiously viewed. Here, we highlight some points that need further discussion.

First, the authors investigated the association between on-treatment HCC risk and various baseline characteristics. However, some indicators (recently emerging biomarkers: quantified hepatitis B surface antigen (HBsAg)4 5; common clinical characteristics: serum albumin,2 diabetes …