Why do some major triplets not need treatment, while some minor triplets need treatment instead? In fact, the need for treatment does not depend on whether there is a major or minor triplet, but rather on whether there is inflammation in the liver. If there is an attack of hepatitis, treatment is needed regardless of whether the e antigen is positive or negative. If there is no attack, the liver function is normal and there is no inflammatory manifestation in the liver pathological tissue examination, it means that the person is a carrier of hepatitis B virus, regardless of major or minor triplet, and does not need treatment, but must go to the hospital regularly for examination. Why is it that carriers have been tested for hepatitis B virus, but do not need treatment? This starts with the onset of hepatitis B and the immune status of the body. After the hepatitis B virus infects the body, it generally goes through four stages without external effects such as drugs. Phase I: Immune tolerance phase After the hepatitis B virus infects the body, it lives mainly in the liver cells. During this period, the body’s immune surveillance system does not recognize the hepatitis B virus and mistakes it for one of its own, so it does not remove it. These viruses are free to replicate in the liver cells and do not affect the normal function of the liver cells for the time being, nor does the liver show any inflammation. Hepatitis B carriers are in this immune tolerant state. Phase 2: Immune clearance After the hepatitis B virus has been latent in the body for a period of time (the latency period varies for each person), our immune surveillance system will slowly detect the “enemy” and initiate an immune response, producing immune cells and antibodies. These antibodies recognize the antigen of the hepatitis B virus and bind to it, forming immune complexes. These immune complexes are engulfed by phagocytes in the body and then excreted outside the cells. We can imagine the hepatocytes as a house, the hepatitis B virus as a group of thieves who sneak in, the body’s immune system as the monitor inside the house, and the immune substances as the police. When the monitoring system alarms, a group of police officers come from all directions of the house. When the police and the thieves fight, the doors, windows and furniture inside the house will be easily broken. Therefore, liver cells in the immune clearance period have an inflammatory response because the virus and the immune system are “fighting” and making a mess of the liver cells. When the liver cells are “injured”, an inflammatory response occurs. At this time, the cell membrane permeability of the liver cells is changed or even damaged, and the transaminases inside the cells enter the bloodstream. A liver function test will show a significant increase in serum aminotransferases (i.e., elevated ALT levels), which is a signal that hepatitis may be developing and that the carrier may be developing hepatitis B. At this point, antiviral treatment should be considered. At this point, antiviral treatment should be considered. Stage 3: Inactive phase After an intense battle, some of the hepatitis B virus will be cleared by the immune system, or the virus may be cleared by aggressive drug therapy. By viral clearance, we mean that the DNA of the hepatitis B virus is no longer detectable in the blood, but some of the virus may still remain in the liver. During this period, the hepatitis B virus is in an inactive carrier state, its ability to replicate is inhibited, and the virus level is low, so it will not be active for a while. Stage 4: Reactive phase Patients who are in the inactive phase may have the hepatitis B virus become active again under certain triggers, such as a decline in immunity or chemotherapy, and the liver may have another inflammatory response, that is, another attack of hepatitis. Now I will answer the question raised at the beginning – why do carriers not need treatment? Because hepatitis B carriers in the immune tolerance period have a relatively peaceful hepatitis B virus in their bodies, which does not provoke the liver cells, and the two can live together peacefully, usually without causing significant liver function damage. Therefore, antiviral treatment is not needed for the time being.