{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T16:48:38Z","timestamp":1761324518735,"version":"3.41.2"},"reference-count":14,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["SAGE Open Medical Case Reports"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p> Worldwide, chronic hepatitis B virus infection remains the main aetiology of hepatocellular carcinoma, while human immunodeficiency virus may hasten the evolution of hepatocellular carcinoma in those co-infected with hepatitis B virus\/human immunodeficiency virus. We describe a 29-year-old female with unmonitored hepatitis B virus infection for over 5\u2009years, human immunodeficiency virus disease on a tenofovir-based antiretroviral regimen for 11\u2009months, who presented with a 2-week history of epistaxis and abnormal vaginal bleeding, associated with unintentional weight loss of 4\u2009months duration. After extensive investigation, a definitive diagnosis of hepatocellular carcinoma was established based on histopathological assessment in the presence of a positive hepatitis B envelope antigen, mildly raised alpha feto-protein, and a non-cirrhotic liver. Periodic surveillance for hepatocellular carcinoma in patients with chronic hepatitis B virus infection is important, particularly in those with evidence of actively replicating hepatitis B virus for early detection and implementation of curative therapies to reduce mortality and morbidity. <\/jats:p>","DOI":"10.1177\/2050313x231168292","type":"journal-article","created":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T09:08:43Z","timestamp":1682413723000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["A convoluted path to the diagnosis of hepatocellular carcinoma in a resource-limited setting"],"prefix":"10.1177","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6947-1482","authenticated-orcid":false,"given":"WC","family":"Sithole","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, King Edward VIII Hospital and Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5604-645X","authenticated-orcid":false,"given":"S","family":"Pillay","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, King Edward VIII Hospital and Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8102-6816","authenticated-orcid":false,"given":"B","family":"Mbanjwa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, King Edward VIII Hospital and Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Magula","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Clairwood Hospital and Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,4,25]]},"reference":[{"key":"bibr1-2050313X231168292","unstructured":"Schwartz J, Carithers RL, Sirlin CB, et al. Clinical features and diagnosis of hepatocellular carcinoma, 2019, https:\/\/www.uptodate.com (accessed 13 June 2020)."},{"key":"bibr2-2050313X231168292","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1713263"},{"key":"bibr3-2050313X231168292","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-020-01372-2"},{"key":"bibr4-2050313X231168292","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.10.013"},{"key":"bibr5-2050313X231168292","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0196057"},{"issue":"8","key":"bibr6-2050313X231168292","first-page":"35","volume":"108","author":"Zakharia K","year":"2018","journal-title":"S Afr Med J"},{"key":"bibr7-2050313X231168292","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1810477"},{"key":"bibr8-2050313X231168292","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2772-3"},{"key":"bibr9-2050313X231168292","unstructured":"Colombo M, Sirlin CB. 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