We are sincerely grateful for the comments and praises of Drs. Chen and Liaw on our paper.1 We made a deliberate decision not to separate patients with cirrhosis from patients without cirrhosis in our analysis. Other than in patients with obvious clinical manifestations of cirrhosis such as varices, shrunken liver, splenomegaly, and ascites, we believe that the diagnosis can be reliably made only by biopsy. We think that ultrasonographic diagnosis of cirrhosis in patients with livers of normal size is unreliable and may in fact contribute to the confusion concerning the risk factors for the development of cirrhosis in various published series. That was the reason why in Dr. Y-F Liaw's recent study on the effect of lamivudine in patients with cirrhosis, biopsy was mandatory for entrance into the trial.2 We did not think it was ethically justifiable to perform mandatory liver biopsies in all 92 of our patients. However, as Drs. Chen and Liaw have noted, we did specifically mention the clinical pointers to cirrhosis in those patients who continued to have disease progression even after hepatitis B surface antigen seroclearance.
Man-Fung Yuen M.D.*, Danny Ka-Ho Wong M.Sc.*, Ching-Lung Lai M.D.*, * Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.