Title: Natural history of decompensated cirrhosis with serum hepatitis B DNA < 2000IU/mL:
a retrospective study
Version: 1 Date: 20 Sep 2022
Reviewer:  Gibril Ndow
Reviewer's report:
Thank you for sharing your work, which aimed to study the natural history of hepatitis B
related decompensated cirrhosis or hepatocellular carcinoma in patients who have either low
or undetectable HBV viremia and/or hepatitis B surface antigen (HBsAg) seroconversion.
Although several studies have demonstrated the relationship between high HBV DNA viral load
and liver disease progression, the risk of advanced liver disease in patients who have sustained
low HBV viremia and/or cleared HBsAg is not well studied. Therefore, this study could fill
important knowledge gaps.
In my opinion, your study was not appropriately designed to answer these questions, and the
results are presented incoherently and difficult to follow. Clearly defining groups to compare
will present results better and improve quality of study. For example, the study population, all
of whom have advanced liver disease, could be categorised into four groups for analysis:
1. HBsAg negative and undetectable viral load (cleared infection)
2. HBsAg negative and detectable viral load (101-2,000IU/mL)
3. HBsAg positive and undetectable viral load (<100IU/mL)
4. HBsAg positive and detectable viral load (100-2,000IU/mL)
Other minor issues to look into:
1. Please clarify at what time point were viral markers assessed - was this at time of diagnosis
of decompensated cirrhosis/HCC?
2. Please fully write out the meaning of LLV in the abstract where it is first used in the manuscript
(I will suggest completely doing away with this and using universally accepted terminology
rather than LLV. And if used, clearly define LLV and clarify whether it includes patients with
undetectable viral load)
3. Remove reference of the South Korea study (Hang et al) in the results section
Title: Natural history of decompensated cirrhosis with serum hepatitis B DNA < 2000IU/mL:
a retrospective study
Version: 1 Date: 20 Sep 2022
Reviewer:  Gibril Ndow
Reviewer's report:
Thank you for sharing your work, which aimed to study the natural history of hepatitis B
related decompensated cirrhosis or hepatocellular carcinoma in patients who have either low
or undetectable HBV viremia and/or hepatitis B surface antigen (HBsAg) seroconversion.
Although several studies have demonstrated the relationship between high HBV DNA viral load
and liver disease progression, the risk of advanced liver disease in patients who have sustained
low HBV viremia and/or cleared HBsAg is not well studied. Therefore, this study could fill
important knowledge gaps.
In my opinion, your study was not appropriately designed to answer these questions, and the
results are presented incoherently and difficult to follow. Clearly defining groups to compare
will present results better and improve quality of study. For example, the study population, all
of whom have advanced liver disease, could be categorised into four groups for analysis:
1. HBsAg negative and undetectable viral load (cleared infection)
2. HBsAg negative and detectable viral load (101-2,000IU/mL)
3. HBsAg positive and undetectable viral load (<100IU/mL)
4. HBsAg positive and detectable viral load (100-2,000IU/mL)
Other minor issues to look into:
1. Please clarify at what time point were viral markers assessed - was this at time of diagnosis
of decompensated cirrhosis/HCC?
2. Please fully write out the meaning of LLV in the abstract where it is first used in the manuscript
(I will suggest completely doing away with this and using universally accepted terminology
rather than LLV. And if used, clearly define LLV and clarify whether it includes patients with
undetectable viral load)
3. Remove reference of the South Korea study (Hang et al) in the results section
Please review this paper.
user
Title: Natural history of decompensated cirrhosis with serum hepatitis B DNA < 2000IU/mL:
a retrospective study
Version: 1 Date: 20 Sep 2022
Reviewer:  Gibril Ndow
Reviewer's report:
Thank you for sharing your work, which aimed to study the natural history of hepatitis B
related decompensated cirrhosis or hepatocellular carcinoma in patients who have either low
or undetectable HBV viremia and/or hepatitis B surface antigen (HBsAg) seroconversion.
Although several studies have demonstrated the relationship between high HBV DNA viral load
and liver disease progression, the risk of advanced liver disease in patients who have sustained
low HBV viremia and/or cleared HBsAg is not well studied. Therefore, this study could fill
important knowledge gaps.
In my opinion, your study was not appropriately designed to answer these questions, and the
results are presented incoherently and difficult to follow. Clearly defining groups to compare
will present results better and improve quality of study. For example, the study population, all
of whom have advanced liver disease, could be categorised into four groups for analysis:
1. HBsAg negative and undetectable viral load (cleared infection)
2. HBsAg negative and detectable viral load (101-2,000IU/mL)
3. HBsAg positive and undetectable viral load (<100IU/mL)
4. HBsAg positive and detectable viral load (100-2,000IU/mL)
Other minor issues to look into:
1. Please clarify at what time point were viral markers assessed - was this at time of diagnosis
of decompensated cirrhosis/HCC?
2. Please fully write out the meaning of LLV in the abstract where it is first used in the manuscript
(I will suggest completely doing away with this and using universally accepted terminology
rather than LLV. And if used, clearly define LLV and clarify whether it includes patients with
undetectable viral load)
3. Remove reference of the South Korea study (Hang et al) in the results section
assistant