Tseng TC, et al. – This study was performed to investigate whether fibrosis–4 (FIB–4) index, a liver fibrosis biomarker, helped in identifying hepatitis B virus (HBV) carriers with the lowest hepatocellular carcinoma (HCC) risk. FIB–4 index <1.29 complemented the existing clinical profile to define patients with the lowest HCC risk in non–cirrhotic patients with chronic HBV infection.

• For an average period of 16.02 years, 2075 treatment-naive Taiwanese patients with chronic HBV infection were followed.
• At baseline, none of them had liver cirrhosis.
• The authors investigated whether a low FIB-4 index complements the favourable predictors to defines patients with the lowest HCC risk.
• They validated the finding in 532 non-cirrhotic patients receiving long-term nucleos(t)ide analogue (NUC) treatment with suppressed viral replication.

• In this study, 137 treatment-naive and 10 NUC-treated patients developed HCC, respectively.
• The authors observed that when baseline FIB-4 index >1.29 in the treatment-naive cohort, HCC risk started to increase.
• Compared to those with FIB-4 <1.29, patients with FIB-4 >1.29 were correlated with a higher risk of HCC with a hazards ratio of 5.56 (95% confidence interval: 3.93–7.86).
• More significantly, baseline FIB-4 index helped stratify different HCC risks such that none of 326 HBeAg-negative patients with FIB-4 index <1.29, ALT level <40 U/l, and HBsAg level <1,000 IU/ml developed HCC among patients with low viral load (HBV DNA level <2,000 IU/ml).
• Moreover, in the validation cohort receiving long-term NUC treatment, the patients with the FIB-4 index <1.29 consistently had the lowest HCC risks.