In my work, I often encounter patients and friends ask me this way, doctor, like my situation in the end need treatment, some doctors tell me need treatment, some doctors tell me do not need treatment, why is there a difference in the statement, I should listen to who in the end, I’m very contradictory and very confused, can you tell me why. First of all, what kind of patients are chronic hepatitis B patients, no matter what the reason is to find hepatitis B surface antigen (HBsAg) positive, carrying more than half a year, and can not be cleared by the body to appear surface antibodies – protective antibodies (HBsAb), and liver function abnormalities, it is a chronic hepatitis B patients, of course, this does not include patients who once had liver function abnormalities, and after treatment liver function is normal. After the human body is infected with hepatitis B virus, especially adults, the majority of people in the proportion of about 80% or more, relying on their own immunity to completely remove the virus and achieve self-healing, hepatitis B five show three antibody positive or two antibody positive (surface antibody must be positive), this group is not chronic hepatitis B patients, and at the same time, will not be infected and re-infected, and realize the lifelong immunity against hepatitis B. The earlier the age of infection, the earlier the age of the hepatitis B virus is, the more the liver function is abnormal. The earlier the age of hepatitis B virus infection, the greater the tendency to chronicity, the more difficult it is to treat, the greater the risk of liver failure during the immune clearance period, and the greater the risk of cirrhosis and liver cancer, which is why babies are immunized against hepatitis B at birth. Patients with chronic hepatitis B go through several stages, one, the immune tolerance period, during which the patient’s viral load is high, liver function is normal or slightly abnormal, the patient has no special discomfort, and the virus can coexist peacefully with each other, antiviral treatment is usually not recommended during this period, if the patient is older than 40 years old, and there is a family history of aggregation of hepatitis B and cirrhosis and liver cancer, and the patient’s viral load is high, the patient can choose antiviral treatment. The choice of interferon or nucleotide analogs depends on the patient’s condition, but once the interferon treatment cannot adapt to various side effects and the viral load decline is not obvious in three months of treatment, the first-line anti-hepatitis B virus drugs recommended by the current guidelines, such as entecavir and tenofovir. Of course, the specific treatment measures and indications must be completed under the guidance of hepatologists. Second, the immune clearance period, after the peaceful coexistence of the immune tolerance period, the virus after a large number of replication, the body’s immune system began to mobilize, began to large-scale clearance of the hepatitis B virus, in the clearance of the virus at the same time, it will cause damage to their own hepatocytes, resulting in a series of liver biochemical indexes such as aminotransferases, etc., the risk of liver failure is very great, so the choice of anti-hepatitis B virus treatment in this period is the most Therefore, it is most necessary to choose anti-hepatitis B virus treatment in this period. Of course, antiviral treatment should also strictly grasp the indications, if the liver function transaminases are elevated above 10 times the normal limit and the patients with cirrhosis are not suitable for interferon antiviral treatment, patients with history of mental illness and pregnancy are also not suitable for interferon treatment, and patients who cannot tolerate the side effects of interferon and those who have not had a good effect for three months are not suitable for interferon antiviral treatment, so it is necessary to choose the highly drug-resistant treatment as early as possible, so the risk of liver failure is very great. Therefore, high drug resistance barrier and efficient nucleoside antiviral drugs such as tenofovir and entecavir should be chosen as early as possible. Inactive or low replication phase, after the previous immune clearance and antiviral treatment, the disease tends to stabilize, E antigen seroconversion may or may not occur during this period, the blood viral load is undetectable or fluctuates in the low load range, the liver biochemistry is normal or fluctuates abnormally in the low level, and the clinical symptoms disappear or ease. Fourth, the re-activation period, manifested as viral replication is stimulated again, a series of liver biochemistry, liver histology and other abnormalities will occur. Current scientific research has confirmed that the persistence of viral replication and liver inflammation is the main culprit leading to cirrhosis and hepatocellular carcinoma, so once the condition needs to be treated with antiviral treatment must be timely antiviral treatment, and one-dimensional hepatoprotective enzyme-lowering treatment can not solve the fundamental problem, why is it difficult to cure chronic hepatitis B because the viral genome has been integrated into the genome of the liver cells, and it will be copied along with the replication of the liver cells, which can not be completely cured by the current antiviral drugs. The current antiviral drugs can not completely remove the template for viral replication (hepatitis B virus cccDNA covalent ring-closed DNA), although the current antiviral treatment to achieve a cure in very few cases, but if not antiviral treatment will soon progress to cirrhosis and liver cancer, and then it will be too late to treat again, at present, can make the slow hepatitis B virus is under control, the condition tends to be stabilized is a great success, the patient can also get a good life. Patients can also get a very good life expectancy and quality (of course, patients bear the psychological pressure and economic pressure is also very big, we must understand them), of course, at present, to clear the hepatitis B virus replication template of the new drug foreign countries have been in the test, I believe that in the future the complete conquest of hepatitis B can be realized, but do not antidisease treatment will soon develop into end-stage liver disease, and by then can only hope that the drug is not enough. So anti-hepatitis B virus treatment and liver enzyme treatment is the most scientific and effective treatment, other are not treating the symptoms of the disease, lose a wife and soldiers. It is not very comprehensive, if you have doubts in this regard you can consult me online, I will see the first time to reply to you. I wish you good health.