We thank Dr. Lai and Dr. Liao for seeking clarification on a possible point of confusion in our review of risk factors for hepatocellular carcinoma.1 One must be careful not to confuse regular surveillance for hepatocellular carcinoma with a proper initial evaluation and subsequent monitoring for cirrhosis in patients with a chronic hepatitis C virus infection. The current guidelines appropriately do not recommend regular surveillance for hepatocellular carcinoma in hepatitis C patients without cirrhosis, and the focus of the guidelines is not the diagnosis of cirrhosis or recommendations for how to follow patients who do not have cirrhosis but are at risk of developing it. A number of tools for the diagnosis of cirrhosis are available to clinicians; these include serological tests, FibroScan, and histology as determined by liver biopsy.2 In the event that cirrhosis develops, these patients can then undergo regular surveillance for hepatocellular carcinoma.
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D. Alan Herbst B.A.*, K. Rajender Reddy M.D.*, * Viral Hepatitis Center University of Pennsylvania Philadelphia, PA.