Judgment
Many HBsAg-positive patients wish they were just a carrier of the virus. So how do you determine this? In layman’s terms, a chronic hepatitis B carrier is a person who is infected with the hepatitis B virus with low viral replication and no or only minor liver tissue damage. Currently, it is not considered that antiviral treatment is needed. Chronic hepatitis B carriers should meet the following criteria.
1, HBsAg positive for more than 6 months.
2. HBeAg positive or negative.
3. Anti-HBe negative or positive.
4. HBVDNA <104 copies/ml;
5. Continuous normal ALT/AST.
6, liver histological necrosis score ≤ 4.
Except for item 6, which is not easily grasped by patients, the other 5 items can be obtained from relevant blood tests in the outpatient clinic.
Misclassification
There are two conditions that can lead to misclassification.
One is “occult chronic hepatitis”, which may or may not have a history of hepatitis B. HBsAg is negative, anti-HBc is positive, ALT fluctuates, and HBVDNA is positive, but viral mutation is excluded. Due to HBsAg negativity, one mistakenly thinks that one is not infected with the virus or that the virus has been completely cleared and relaxes one’s vigilance.
The other is that the carrier state is unknowingly transformed into an active replication state (HBVDNA increases >10-fold), but no clinical symptoms appear and they think they are still “carriers”.
Potential risks
Chronic hepatitis B carriage is a state of low viral replication rather than a state of no viral replication, let alone a state of viral freedom. The current sensitive detection technology can detect HBVDNA above 10 copies/ml, and the lower limit of 500 copies/ml or 300 copies/ml is usually used in clinical practice, thus significantly improving the detection rate of HBVDNA and providing an important tool for diagnosis and judging the effectiveness of treatment. Many studies have shown that a proportion of chronic hepatitis B carriers still develop severe chronic hepatitis, cirrhosis and liver cancer. Another potential risk is the chance of transmission to close friends, relatives and children. Hepatitis B is transmitted through blood, but infection can occur when a small amount of virus enters the bloodstream. Therefore, the possibility of infection exists in the case of an unnoticeable mucosal skin breakdown. So, how can a person with chronic hepatitis B virus live with themselves?
Protect yourself
1, maintain a positive and happy state of mind With the current level of medical care, it is entirely possible
The current level of medical care makes it possible for chronic hepatitis B carriers to be free of hepatitis B problems. We already have a relatively effective medical monitoring mechanism, and there are many antiviral drugs, and the basic research on hepatitis B virus infection is constantly deepening, and new breakthroughs are constantly emerging. A positive state of mind is a good scientific basis for enhancing the body’s immune system.
2, correcting bad habits drinking, smoking, long-term fatigue work experience
Frequent late nights, indiscriminate intercourse, lack of physical activity, excessive or inadequate nutrition (improper weight loss), etc. may reduce immunity, resulting in active viral replication. Alcohol and fatty liver are especially harmful to chronic hepatitis B carriers. This has been well documented in clinical studies.
3.Prevent and control colds and secondary bacterial infections.
4.Check liver function, two-to-one half (quantitative method) once every 6 months
HBVDNA quantification, hepatobiliary and splenic ultrasound and alpha-fetoprotein (AFP). It is helpful to detect changes in time.
Marriage
If the other party is uninfected, the other party must be required to be vaccinated against hepatitis B. The Center for Disease Control and Prevention has this service. And the anti-HBs titer should be at least 10mU/ml to be protective. If this standard is not reached after vaccination, the immunization should be boosted under the guidance of a doctor.
Fertility
Male carriers have less effect on newborns.
Female carriers should be tested before pregnancy to determine their status and treated accordingly. Infection of the newborn with hepatitis B virus rarely occurs in utero, but in most cases the risk of infection is during delivery and the initial management after delivery, when the placenta, vaginal blood and umbilical cord blood are sources of infection. Therefore, it is best for carriers to deliver in an experienced hospital to reduce the chance of hepatitis B virus infection in the newborn.
Babies born to mothers with chronic hepatitis B virus should be given 200 U of anti-hepatitis B immunoglobulin and 10ug of recombinant hepatitis B vaccine within 12 hours of birth, 10ug of hepatitis B immunoglobulin at 1 month of age and a second dose of hepatitis B vaccine at another site, and a third dose of vaccine at 6 months of age. This completes the immunization program for newborns against hepatitis B. According to statistics, 90% of newborns who complete the above immunization program are protected. However, the parents’ responsibility does not end there. If the anti-HBs titer of an infant is between 10mU/ml and 100mU/ml after hepatitis B vaccination, it means that the infant already has some immunity, but it is not yet consolidated, so it is advisable to give a booster dose of hepatitis B vaccine after 6 months. If the anti-HBs titer is above 100mU/ml and below 1000mU/ml, then retest once after 1~2 years, if it is above 1000/ml. Then retesting again in 4~6 years is enough. If the measurement result is below 10mU/ml, you should retest immediately.