Who is on antiviral therapy?

  Antiviral therapy for chronic hepatitis B mainly refers to nucleoside analogues or interferon application. Among all hepatitis B-related treatments, including immunomodulation, anti-inflammatory liver protection and enzyme lowering, and anti-fibrosis among which antiviral therapy is the key, standardized antiviral therapy should be administered as long as there is an indication.  In the Hepatitis B Guidelines of various countries, the general indications for antiviral treatment of chronic hepatitis B include: 1, HBD DNA ≥1×105 copies/mL; HBeAg negative ≥1×104 copies/mL.  2, ALT ≥ 2 × upper limit of normal value; if interferon is used, ALT should be ≤ 10 × upper limit of normal value and total blood bilirubin level should be < 2 × upper limit of normal value.  3, such as ALT < 2 × upper limit of normal value, but the liver histological activity score index ≥ 4, or the degree of inflammation and necrosis ≥ G2. Those who do not meet the above treatment criteria, should be monitored for changes in the disease.  At the same time, I believe that patients with a clear family history of hepatitis B and multiple occurrences of cirrhosis or hepatocellular carcinoma in the family should be mobilized to start treatment as early as possible, not necessarily waiting for abnormal liver function. This is because such patients tend to progress faster, and if treatment is not started early, most of them will eventually develop cirrhosis or even liver cancer.  The currently approved antiviral drugs in China are, lamivudine, adefovir, entecavir, telbivudine and interferon (both regular and long-acting interferon).  Before deciding to use interferon care should be taken to check if the patient has clear contraindications such as: psychiatric disorders, severe heart disease, diabetes, thyroid disease, autoimmune diseases, etc.