The antiviral treatment for hepatitis B is the key to controlling the progression of the disease, and there may be problems with drug resistance in the course of treatment, but in fact, drug resistance is common to all nucleoside (acid) analogues and is not the “patent” of any drug. “The patient does not need to be at a loss. From viral mutation to the onset of drug resistance, drug resistance can be divided into three stages: genetic resistance, virological resistance and clinical resistance. The actual fact is that you will need to be aware of the changes in the hepatitis B virus in the course of the anti-viral process to prevent it from mutating and then fighting back. Therefore, it is necessary to adopt the “three no’s” policy, while keeping in mind the optimization of treatment and effective management of drug resistance throughout the process. Don’t give up – regular monitoring and follow-up After starting antiviral treatment, some hepatitis B patients have obvious efficacy, not only HBV DNA has decreased, liver function has also been significantly improved. As a result, they are prone to complacency and adopt a sheep grazing attitude towards the hepatitis B virus, allowing it to develop freely. Unbeknownst to them, the hepatitis B virus has a wolf’s heart, and behind the calmness of the wind and waves is a conspiracy. When given a little time to survive, it will secretly “mutate” and “replicate”. Once the mutated strain becomes the mainstay, the patient’s HBV DNA levels rebound, and if no intervention is made at this point, it will turn into clinical resistance. Therefore, in the course of hepatitis B antiviral treatment, it is important to insist on regular follow-up, checking HBV DNA levels and liver function every three months. Don’t miss – 24 weeks critical treatment time The opportunity is not lost. Optimizing treatment can prevent the occurrence of drug resistance. The main point in optimizing treatment is to test the patient’s HBVDNA level at six months (24 weeks), at which time the doctor will determine the efficacy based on the test results and change the treatment strategy accordingly. If the HBV DNA level is not measurable, it means that the effect is good and monotherapy can be continued; if the HBV DNA level has decreased but is still measurable, it means that the efficacy is not good and there is a higher chance of drug resistance in the long term, and additional drugs are needed for combination therapy. As the name implies, optimization of treatment is to improve the efficacy of antiviral therapy, at what point in time optimization and how to optimize is the key, hepatitis B patients do not miss the best time to optimize – 24 weeks (six months), more for themselves to take some initiative. No blindness – stopping and changing medication on your own Impulsivity is the devil, and hepatitis B treatment should never be done blindly. Some hepatitis B patients let their doctors change their medications once they reach six months, regardless of the effectiveness of the treatment. Some patients even have “tricks”, not only to stop their own medication, but also to buy drugs online to eat. In fact, blindly stopping and changing medication can easily make drug resistance visit in advance. There is now a consensus in the field of hepatitis B treatment that optimal treatment is the best option to prevent drug resistance and improve efficacy. In the course of oral antiviral therapy, if monotherapy is found to be ineffective at 14 weeks of treatment, a drug without cross-resistance sites can be added, i.e. combination therapy, which can rapidly suppress the mutated virus and bring HBV DNA levels under control again with good long-term efficacy and lower drug resistance. In-depth understanding of drug resistance and comprehensive view of antiviral therapy The issue of drug resistance in hepatitis B antiviral therapy is often overemphasized, so much so that some patients are afraid to start antiviral therapy for fear of drug resistance, while others choose new and expensive drugs in order to avoid drug resistance, regardless of their financial ability. Avoiding drug resistance is only a good wish that people can’t achieve at the moment, and managing drug resistance and preventing it is the best policy. The aim of hepatitis B treatment is to delay the development of cirrhosis and liver cancer. Several studies of lamivudine have confirmed that the progression of hepatitis B can be delayed and drug resistance can be managed, especially the optimized therapy that has been commonly recommended in recent years to predict the emergence of drug resistance at the 24-week HBV DNA test, and to prepare a response in case of drug resistance -Combination therapy, such a well-thought-out treatment plan, makes drug resistance nowhere to be seen. Therefore, it is important for hepatitis B patients to be firm in their message of antiviral treatment and to take up the weapon of optimal treatment, leaving no room for drug resistance.