In this road of hepatitis B treatment, hepatitis B patients have to go through all kinds of tests, in order to make the hepatitis B antiviral effect half the effort, hepatitis B patients will need to record the golden code of antiviral, and remind themselves from time to time not to take a detour in the antiviral reasoning, fork in the road, and under the guidance of professional doctors antiviral. Anti-viral is the key to hepatitis B treatment, golden code one: to figure out the timing of anti-viral Anti-viral should be timing, not all people infected with hepatitis B virus need to be treated. Hepatitis B virus carriers do not need antiviral treatment even if their HBV DNA levels are high, as long as their liver function is normal. However, it is important to insist on regular testing and not to take it lightly. According to the latest “Expert Consensus on Antiviral Therapy for Chronic Hepatitis B” published in 2010, patients with HBV DNA levels above 1×104 copies/ml and/or serum ALT levels above the upper limit of normal, and liver biopsies showing severe to severe active inflammation, necrosis and/or liver fibrosis need antiviral therapy. In addition, patients with liver biopsies showing severe to severe active inflammation, necrosis, and/or fibrosis should also begin antiviral therapy immediately. Antiviral is the key to hepatitis B treatment. Golden Rule 2: Adhere to long-term antiviral The hepatitis B virus is very tenacious and so far no drug has been able to completely eliminate it. The clinical findings show that interferon can only inhibit the replication of the hepatitis B virus, and after short-term treatment (≤ 1 year), the patient’s HBV DNA level will rebound significantly, which means that hepatitis B treatment requires “long-term treatment” in order to “long-term security”. For the course of antiviral drugs, the Chinese Hepatitis B Prevention and Control Guidelines recommend that: after 1 year of treatment, if HBV DNA levels turn negative and liver function is normal and serological conversion has been achieved, patients with major hepatitis B need to consolidate treatment for another 12 months; after 1 year of treatment, if HBV DNA levels turn negative and liver function is normal, patients with minor hepatitis B need to consolidate treatment for another 18 months. In short, patients with hepatitis B must adhere to oral antiviral therapy for at least two or two and a half years before they can scientifically discontinue it. Anti-viral is the key to hepatitis B treatment, golden rule three: regular monitoring and follow-up Both hepatitis B carriers and hepatitis B patients need regular monitoring and follow-up, which assumes three major functions that should not be ignored. First, regular monitoring can determine the progress of the disease. Hepatitis B carriers can rely on it to decide whether antiviral is needed, while hepatitis patients who are taking medication can learn about the progress of the disease to prevent the development of cirrhosis and liver cancer. Second, monitoring allows early detection of drug side effects and timely intervention to prevent medical errors. In addition to routine tests, patients with hepatitis B have to add monitoring items according to the characteristics of certain types of drugs, such as CK levels, creatinine, etc. Third, the monitoring results are also a litmus test for the efficacy of the treatment. If the results are not good, the doctor can adjust the treatment plan according to the patient’s condition in time. Therefore, patients need to actively cooperate with their doctors and do regular monitoring and follow-up, such as monitoring HBV DNA level, liver function and hepatitis B five items once every three months. Anti-viral is the key to hepatitis B treatment, golden rule four: the choice of drugs to comply with the “three less” principle Hepatitis B oral anti-viral treatment requires long-term, the choice of drugs to comply with the “three less” principle: less cirrhosis, liver cancer; less adverse reactions and less cost. After full communication with doctors, hepatitis B patients need to consider these three factors and choose the most suitable antiviral drugs for themselves. Reducing cirrhosis and liver cancer, thus prolonging life and improving quality of life is the ultimate goal of hepatitis B treatment. The landmark 4006 three-year study in the field of hepatitis B treatment found that 3 years of treatment with a nucleoside analogue (lamivudine) reduced disease progression by 55% and the occurrence of liver cancer by 51%. In addition, the 10-year follow-up data from the 4006 study showed that adherence to long-term oral antiviral therapy not only resulted in significant improvement in liver fibrosis, but even reversed early cirrhosis in individual patients. The four major nucleoside (acid) analogues currently available in China are all safe and adverse effects are relatively rare. However, as the population expands during treatment, combined medications and individual differences emerge, drug side effects are showing their “fox tails”. Since hepatitis B treatment requires at least 2-3 years, hepatitis B patients should try to choose drugs that have been on the market for a long time, are widely used by the population, and have few adverse reactions for safety reasons. Although nucleoside (acid) analogs are in the national medical insurance catalog, which saves some money for hepatitis B patients, the reimbursement rate of medical insurance is still linked to the price of the drug, plus the cost of testing, outpatient fees, other liver-protective drugs, and lost wages, the annual cost is still high. Therefore, when choosing drugs for hepatitis B patients, they must first weigh their pockets and choose drugs that they can stick with for at least 2-3 years. Don’t just follow the trend of choosing new high-priced drugs, which may accelerate the deterioration of the disease due to the shortage of funds to reduce the dosage and discontinue the medication during the treatment. Anti-viral is the key to hepatitis B treatment. Golden Code 5: Optimize treatment and prevent drug resistance A number of clinical trials at home and abroad have confirmed that six months (24 weeks) is the key time point in the oral anti-viral process. At this time, according to the test results, the treatment can be optimized to prevent the occurrence of drug resistance. The viral level is monitored at six months (24 weeks) from the start of treatment, and if the patient’s HBV DNA is less than 3 times 10, it indicates that the efficacy is very satisfactory and monotherapy can be continued. If, after six months of treatment, the patient’s HBV DNA level has decreased but is still greater than 3 times 10, it is a sign that the efficacy is not very satisfactory and drug resistance may occur in the long term, requiring adjustment of the treatment regimen. Nowadays, more and more doctors recommend the use of the most advanced virus YMDD testing technology (role: disease analysis, virus quantification, virus typing, virus mutation test, virus drug resistance test, drug efficacy assessment, etc.). Comprehensive understanding of the disease, scientific use of drugs, targeted use of anti-hepatitis B virus drugs.