I. What is hepatitis B? Viral hepatitis B (“hepatitis B”) is an infectious disease caused by the hepatitis B virus (HBV). This virus replicates mainly in liver cells and causes inflammation and necrosis of liver cells by activating the body’s immune cells. The inflammation and necrosis of liver cells gradually accumulates and gradually forms liver fibrosis, which eventually develops into cirrhosis or even liver cancer. In some cases, patients with chronic hepatitis may experience dramatic exacerbation of the disease, manifesting as severe hepatitis and liver failure. The liver is the body’s “chemical plant”, complex functions, very important to the human body, and the heart, commonly known as the “heart and liver baby”. However, a significant number of patients do not have any clinical symptoms during the development of chronic hepatitis. Once clinical symptoms appear, the condition can often be quite serious. Therefore, we call the hepatitis B virus an “invisible killer” and the liver a “silent organ”, and we cannot judge the presence or absence of liver disease or the degree of liver disease by whether we feel well or not. We can only have regular checkups to find out if the liver disease is progressing, what the extent is, and whether treatment is needed. Second, how is hepatitis B transmitted? Hepatitis B virus is mainly transmitted through contact with the blood and body fluids of virus carriers, and the main transmission routes are: 1) vertical transmission from mother to child; 2) close contact between children; 3) unsafe injection and blood transfusion; 4) sexual transmission. The younger the age of infection, the higher the chance of chronicity. Adults with normal immune function who are infected rarely experience chronicity. The high rate of hepatitis B virus infection in China is mainly due to infection during infancy and childhood, especially vertical transmission of infection from mother to child in newborns. Therefore, hepatitis B is a family aggregation phenomenon. The importance of antiviral treatment: chronic hepatitis B is globally distributed, nearly 2 billion people worldwide have been infected with hepatitis B virus, of which about 300 million have become chronically infected. China is a high incidence of hepatitis B, the natural history of development suggests that a significant proportion of people will develop cirrhosis, or even liver cancer, which is extremely dangerous to health. At present, the Chinese patent medicines, Chinese herbal medicines and many so-called “liver protection drugs” on the market are not effective in controlling viral replication, and the miraculous effect they promote is not credible and unscientific. So far, the only treatment that is fundamental is antiviral therapy, which maximizes the control of viral replication or controls hepatitis activity through immunity, leaving the disease in a resting state. The ultimate goal is to stop, reduce or delay the occurrence and development of cirrhosis and hepatocellular carcinoma to the maximum extent possible, improve the quality of life and prolong life. IV. How to choose antiviral treatment? With clear hepatitis B activity, including significantly elevated transaminases for more than 3 months and active viral replication, antiviral therapy is needed regardless of whether it is major or minor triplets. There are currently two types of anti-hepatitis B virus treatment options, one is interferon, which is subdivided into two types: 1) domestic short-acting interferon, which needs to be injected every other day, and 2) imported long-acting interferon, which needs to be injected once a week; the other type is oral nucleoside antiviral drugs, which are currently available for purchase in four types: lamivudine, adefovir, entecavir, and telbivudine. These two types of treatment have their own advantages and disadvantages. The main effect is the transformation of major triplets into minor triplets, the control of hepatitis B virus below the detection line, long-term stable and normal liver function, stable and non-progressive liver disease, and in a small number of patients, negative surface antigen. The disadvantage of interferon is that the side effects are large, but most patients can tolerate it and the side effects can disappear after stopping the drug; another part of patients are contraindications to interferon treatment and are not suitable for treatment with interferon. The advantages of oral nucleoside analogs are that they have few side effects, are convenient to take orally once a day, have basically no contraindications, can be suitable for all patients except those allergic to the drug, have a high response rate during treatment, can quickly control viral replication and stop disease progression. The disadvantage of oral nucleoside analogs is that the treatment time is long, usually at least 3-5 years, and should not be discontinued at will, and easy to rebound after discontinuation; in addition, with the prolongation of drug use, drug resistance is likely to occur, of course, the chance of drug resistance for each drug is unequal, there are high and low. Of course, there is a more mature prevention program and treatment program for drug resistance. Regular follow-up is important: The process of antiviral treatment for hepatitis B is relatively long, ranging from one year (such as injectable interferon) to three to five years (note the word “above”, there is no upper limit, such as oral nucleosides), and many complications may arise, requiring close monitoring under the guidance of a specialist, such as initial assessment of efficacy, side effects and drug resistance. Initial assessment, side effects and drug resistance monitoring, etc. In case of poor efficacy, side effects or drug resistance, the doctor will communicate with the patient and discuss the next treatment plan, whether to change, add, suspend, or discontinue the treatment. Some patients adjust the treatment plan because of the need for fertility; others need to stop the drug for observation because the treatment is effective. We would like to remind our patients that they should not use their own medication or take the initiative to change or stop their medication without the guidance of a specialist. This is because frequent irregular and unsystematic antiviral treatment is wasteful, may aggravate the disease, and may increase the drug resistance of the virus, making future treatment difficult. Hepatitis B carriers also need regular follow-up checkups at the hospital. “It is not yet possible to predict when this will happen, so it is important to follow up regularly. The liver function should be reviewed every 2-3 months for “major triple-positive” carriers and every 3-6 months for “minor triple-positive” carriers, and serum fetoprotein and liver ultrasound should be checked every six months for those over 40 years old to keep track of the evolution of the disease. If abnormalities in liver function occur, active treatment is required. The specific treatment plan should be developed by an experienced hepatologist.