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We appreciate the comments by Chen et al1 on our recent publication entitled ‘Hepatitis B Surface Antigen Level Identifies Inactive Chronic Hepatitis B Patients from Asia with HCC Risk Below Surveillance Threshold’.2 Their comments highlight the heterogeneity among patients with inactive chronic hepatitis B (CHB) and raise an important clinical question: Should nucleos(t)ide analogue (NA) therapy be initiated in patients with inactive CHB with high hepatitis B surface antigen (HBsAg) levels?