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The Risk Evaluation of Viral Load Elevation and Associated Liver Disease\/Cancer\u2010Hepatitis <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content> Virus (<jats:styled-content style=\"fixed-case\">REVEAL<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>) study carried out in Taiwan was used to investigate the natural history of chronic hepatitis <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>. The <jats:styled-content style=\"fixed-case\">REVEAL<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> study has established an <jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> viral load paradigm in the natural history of chronic hepatitis <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">CHB<\/jats:styled-content>). Serum <jats:styled-content style=\"fixed-case\">HBV DNA<\/jats:styled-content> level has been shown to be significantly and independently associated with incidence of hepatocellular carcinoma (<jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content>) and cirrhosis and liver\u2010related mortality across a biological gradient. It is also a major predictor of <jats:styled-content style=\"fixed-case\">HBsAg<\/jats:styled-content> seroclearance. Genetic features including <jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> genotype and basal core promoter <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>1762<jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>1764<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> mutant, and precore <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>1896<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> mutant were documented as predictors of <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> risk. Inactive <jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> carriers still had an increased risk on <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> development and liver\u2010related mortality compared with <jats:styled-content style=\"fixed-case\">HBsAg<\/jats:styled-content> \u2010seronegatives. Nomograms focusing on facilitating risk communication between patients and clinicians were developed incorporating non\u2010invasive clinical parameters to predict long\u2010term <jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content> risk. These will hopefully contribute to evidence\u2010based decisions in the clinical management of <jats:styled-content style=\"fixed-case\">CHB<\/jats:styled-content> patients. A somewhat provocative and novel finding from the <jats:styled-content style=\"fixed-case\">REVEAL<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> study is the association of chronic <jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> infection in active replication with an increased pancreatic cancer risk especially in women less than 50\u00a0years old. This finding will hopefully spur further research in this area seeking confirmatory evidence. Finally, we hope that the <jats:styled-content style=\"fixed-case\">REVEAL<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> study will continue to be a source of data to answer other important questions in chronic hepatitis <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content> research going forward.<\/jats:p>","DOI":"10.1111\/j.1478-3231.2012.02805.x","type":"journal-article","created":{"date-parts":[[2012,4,18]],"date-time":"2012-04-18T03:13:45Z","timestamp":1334718825000},"page":"1333-1341","source":"Crossref","is-referenced-by-count":99,"title":["Natural history of chronic hepatitis <scp>B<\/scp>: what exactly has <scp>REVEAL<\/scp> Revealed?"],"prefix":"10.1111","volume":"32","author":[{"given":"Uchenna H","family":"Iloeje","sequence":"first","affiliation":[{"name":"Global Health Economics and Outcomes Research Bristol\u2010Myers Squibb Co Wallingford CT 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