GPT and hepatocellular carcinoma: Early alanine aminotransferase (ALT) or aspartate aminotransferase (AST) normalization after NA treatment has been shown to reduce the development of cirrhosis and HCC.5 However, even after 1 year of treatment with tenofovir disoproxil fumarate (TDF) or entecavir (ETV), 2 first-line therapies with strong barriers to resistance, the rates of ALT normalization were reported to be 68%-76% and 67%-78%, respectively.5,6 There is limited information on the possible causes of the persistent aminotransferase elevations in CHB patients treated with NAs.