Do all chronic hepatitis B require antiviral treatment? First of all, we have to distinguish between chronic hepatitis B virus carriers and chronic hepatitis B patients. Chronic hepatitis B carriers usually have normal liver function, and if they are E antigen negative, that is, “small triple positive” patients, their condition is usually stable and they do not need antiviral treatment. If the E antigen is positive, that is, patients with “major triple positive” and aged below 30 years old, they do not need antiviral treatment for the time being. For carriers of “triple III” who are >30 years old, especially males or those with a family history of cirrhosis or liver cancer, even if the liver function is normal, it is recommended to do a non-invasive test for liver fibrosis (also known as liver elasticity test) or liver histology to determine whether or not there is liver fibrosis or cirrhosis. To determine whether antiviral therapy is needed. For patients >30 years of age with “minor triple positive”, if HBV DNA is persistently positive, it is also recommended to undergo the above tests to determine the need for antiviral treatment. For chronic hepatitis B patients with abnormal liver function, different antiviral drugs should be used according to the HBV-DNA level, the result of HBV-2.5 and the different conditions of the patients. Can cirrhosis and liver cancer be prevented? If chronic hepatitis B patients are left untreated, 12-25% of them may develop cirrhosis within 5 years. In 5 years, 6%-15% of cirrhotic patients will develop liver cancer. Chronic hepatitis B develops into cirrhosis through the process of liver fibrosis. Timely treatment of chronic hepatitis B can prevent cirrhosis by reducing inflammation in the liver and blocking or reversing the process of liver fibrosis. Liver cancer occurs mostly on the basis of cirrhosis. To prevent liver cancer, the first step is to actively treat chronic hepatitis B and block the progress of liver disease, and the incidence of liver cancer will be significantly reduced. Chronic Hepatitis B Virus Carrier Is it a lifelong carrier? Chronic hepatitis B virus carriers have been infected with hepatitis B virus for more than half a year, have no signs and symptoms of hepatitis, have normal liver function tests, have more than three consecutive follow-up visits within one year, have normal serum ALT and AST, and generally have no obvious abnormalities in liver histologic examination. Some of the chronic hepatitis B virus carriers will turn negative naturally, and the natural conversion rate is about 0.5%~1.0% per year, while most of the patients will carry surface antigen for life. About 25% of chronic hepatitis B carriers will develop the disease at some time, and chronic hepatitis B almost always develops in carriers. Can Hepatitis B surface antigen turn negative naturally? In the natural state, without treatment, after 20~50 years, the body’s immune system can spontaneously clear the hepatitis B virus, HBsAg conversion, anti-HBs positive, the natural conversion rate is about 0.5%~1.0% per year. there are two peaks in the natural conversion of HBsAg, the first peak occurs at the age of 10-20 years old, the natural conversion rate is about 2.7% per year. The second peak occurs after the age of 50, and the annual natural conversion rate can be as high as 6.6%. What should I do if I have been vaccinated against hepatitis B but have not developed surface antibodies? Hepatitis B vaccine is the outer membrane antigen (surface antigen) of the hepatitis B virus produced by genetic recombination technology, which can stimulate the body to produce surface antibodies and protect against infection with the hepatitis B virus. Generally speaking, a surface antibody titer of more than 10 milliunits per milliliter (10mIU/ml) is effective, and more than 100mIU/ml is highly protective . However, there are some people (4%-10%) who cannot detect the surface antibody produced by the body after three doses of hepatitis B vaccine, which may be related to the insufficient dose of the vaccine or the genetic factors that cause the body to be unresponsive to the hepatitis B vaccine. This may be due to insufficient vaccination dose or genetic factors that cause the body to be unresponsive to hepatitis B vaccine. The response rate of hepatitis B vaccine can be increased by increasing the vaccine dosage and the number of times of vaccination, and the 2015 edition of the Guidelines for the Prevention and Control of Chronic Hepatitis B clearly states that the dosage of the hepatitis B vaccine can be increased to 60 μg each time. What’s the difference between triple and triple positive? The terms “major and minor triple positive” refer to the two different results of the hepatitis B antigen 2.5 test (referred to as hepatitis B 2.5). The first pair of the “two halves” is the surface antigen (HBsAg) and surface antibody (anti-HBs), the second pair is the E antigen (HBeAg) and E antibody (anti-HBe), and the third pair is the core antibody (anti-HBc) and core antigen (HBcAg). Since the core antigen has been fully assembled into the hepatitis B virus in the liver cells and there is no free core antigen in the serum, only half of the third pair, i.e., the core antibody, can be detected in the peripheral blood, so it is called the two-half pair. “Major triple positive” means that the surface antigen, E antigen and core antibody tests are all positive. It is generally recognized that “Major Triple Positive” is relatively more contagious and has a higher chance of becoming chronic hepatitis B. “Minor Triple Positive” means that the patient is positive for surface antigen, E antigen and core antibody. Minor triple positive” refers to the surface antigen, E antibody and core antibody test are positive, it is usually from the “major triple positive” transformation, is the human body against the E antigen to produce a certain degree of immunity, generally believe that “minor triple positive” is less contagious. “However, for some people who are negative for both E antigen and E antibody, the hepatitis B virus it is infected with may be a mutated strain of the virus, which cannot express E antigen and E antibody, but if the test for hepatitis B virus deoxyribonucleic acid (HBV-DNA) is still positive, it means that viremia exists and is still contagious. Regardless of whether it is “triple positive” or “minor triple positive”, it only reflects the status of the virus in the body, but does not reflect the normal function of the liver, and therefore cannot be used to determine the severity of the disease. In order to know the condition of liver function, it is better to go to the hospital for liver function and Hepatitis B 2.5 examination regularly (3 months to 6 months). Can the mother breastfeed if she is a chronic hepatitis B carrier? Breastmilk is the ideal nutritious food and drink for infants, so can mothers who are hepatitis B carriers breastfeed their infants? Controlled epidemiologic studies have confirmed that there is no difference in the risk of hepatitis B virus infection between breastfed and non-breastfed infants, as long as the infants are vaccinated with hepatitis B immune globulin and hepatitis B vaccine immediately after birth. In addition, the Chronic Hepatitis B Guidelines state that newborns can be breastfed by Hepatitis B surface antigen (HBsAg)-positive mothers after they have received Hepatitis B immunoglobulin and Hepatitis B vaccine within 12 hours of birth.