Most chronic hepatitis B virus infections are, in fact, not completely cleared. Even if surface antibodies appear after Pyroxin treatment (which is only fortunate for a very small number of patients), a small amount of virus can remain; for the very large majority of infected people, they need to live with the hepatitis B virus for a long time. Isn’t there a strategy to deal with it? Different infection states should have different ways of coping. 1. Is there any virus left in the liver after the antibodies are produced by Peroxin? Will the virus stop replicating after a few years or a decade, because the infected liver cells die of old age and new cells are not infected, so there will be no virus in the liver and you will be able to drink like normal people? 2. If the antibodies come out but the virus in the liver is replicating at a low level, will it still relapse for some reason? Why can’t the chronically infected hepatitis B virus be completely removed? Chronic hepatitis B virus infection is actually very difficult to be completely removed in two ways: 1. During long-term infection, the viral DNA can integrate with the DNA of the liver cell genes, and the integrated virus cannot be removed. 2. After surface antigen/antibody conversion by Pyroxin treatment, there is still a trace amount of residual virus in the hepatocytes that becomes the mother of HBV (cccDNA) present. The integrated HBV DNA and the mother cccDNA of hepatitis B virus exist in the nucleus of the hepatocyte, like a safe, where neither drugs nor immune factors can enter, and the integrated virus and the mother virus live and die with the hepatocyte. The liver cells have to metabolize the nutrients absorbed by the body and convert them into energy to supply the body’s living and working needs; they also have to remove the bacterial toxins from the colon (commonly known as the large intestine, which stores feces). The liver is a complex and delicate biochemical factory with unparalleled functions, and a liver cell is a workshop. Liver cells are needed to maintain human life functions and are characterized by the ability to quickly regenerate after destruction and rarely die without being destroyed. Some inactive carriers recovering from mild chronic hepatitis may, decades later, have forgotten they ever had hepatitis B virus infection. Some individuals, such as those with malignant tumors, are severely immunosuppressed with chemotherapy drugs, and the virus can replicate at astronomical exponential levels, and acute liver failure may occur if antiviral drugs are not taken at the same time. Are all chronically infected hepatitis B viruses not completely removed? Hepatocytes are one of the longest-lived tissue cells in the body, and the fact that the hepatitis B virus survives with the hepatocytes only means that it has been around for a very long time, and whether it can be completely removed is still an open question. Only 25% of chronic hepatitis B virus infected patients have hepatitis activity, and our current problem is only this 25%. Seventy-five percent are asymptomatic carriers of chronic hepatitis B virus who eventually do not develop the disease. Most chronic asymptomatic carriers of “major triplets” who are free of tobacco, alcohol and other accidents will have their viruses reduced by one cp/ml every 4-5 years in men and every 3-4 years in women, and most will turn seronegative at age 45 (men) and 35 (women), respectively, for “minor triplets “Carrying; then after another ten years or so, “small triplet” carrying will end carrying. Because there are no symptoms, many people are unaware that they have ever had such an experience. For people who go through long years and eventually end up as chronic carriers, it is ethically impossible to do a liver puncture to check if the hepatocyte virus has disappeared, because it has no practical meaning for them personally. How do chronic carriers cope with the hepatitis B virus? Although the majority of pediatric and adolescent “major triple-positive” chronic carriers have high viral levels, usually 7 to 8 times cp/ml, there is no hepatocellular inflammation, indicating that the hepatitis B virus itself does not cause direct hepatocellular lesions. Some people have immune maturity in adulthood and lymphocytes attack the liver cells infected with the virus in order to cause hepatitis, which is what causes 25% of chronic infections. The “Big Three” chronic carriers “live peacefully” with the hepatitis B virus and do not need antiviral treatment; without the cooperation of the body’s immune system, antiviral treatment is ultimately ineffective. Therefore, chronic carriers of “major triple-positive” should only have their liver function and viral quantification checked regularly. There will be some “friction” in “peaceful living” (the virus competes for the living materials of the cells), and the liver cells will undergo minor damage, which will accumulate with age, and some liver fibrosis will occur. Some scholars have suggested that chronic carriers of “major triplets” over 60 years of age should also be treated with antiviral therapy. The serum virus level reflects the number of viruses in the liver and the degree of liver lesions in “small triple-positive” infections with normal transaminases. The virus quantification by domestic reagents is less than 4 times cp/ml, which is not active replication and has little impact on health, not enough to diagnose hepatitis, not an indication for antiviral therapy, but the possible progress of the disease must not be missed, liver function and virus quantification must be checked every 3-6 months. What is the purpose of antiviral treatment for chronic hepatitis? Don’t think this is a simple question, in fact, many people have misconceptions and thus adopt strategies with varying degrees of error, even in the opposite direction. It is well known that the current medical environment for hepatitis B has various problems, and many patients have taken detours and even suffered heavy losses. For the patients themselves, lack of clarity about the purpose of treatment is one of the most important subjective factors. The purpose of antiviral treatment is to promote stable recovery of hepatitis and to stop the development of cirrhosis and hepatocellular carcinoma, in short, to live a long and healthy life. At present, the application of first-line nucleoside analogues (entecavir and tenofovir) rarely resistant, few adverse reactions, can quickly control inflammatory activity, can make liver fibrosis reversal, can significantly reduce the incidence of liver cancer, for the vast majority of hepatitis patients, to live a long and healthy life should not be a problem, tenofovir is also very safe for childbirth. However, many patients are concerned about the “medicine (excluding herbal medicine) three points of poison”, the modern scientific development, by the strict clinical trials of drugs have deep doubts; more patients because of the need for long-term medication and hesitation, and therefore delayed. Please see the common chronic diseases: hypertension, diabetes, heart disease, chronic nephritis, etc. Which chronic disease does not require long-term treatment? The first-line nucleoside analogs for chronic hepatitis B are at least one of the best drugs in terms of simplicity, safety, and efficacy. Do I need to pursue surface antigen/antibody conversion for Pyroxine treatment? Pyroxin is designed to stimulate the body’s immunity and eventually achieve a more stable effect. Although there is still a residual virus after surface antigen/antibody conversion, it can inhibit its replication and certainly will not relapse and can be considered cured. If Pyroxin is able to obtain a sustained effect, it is definitely better than nucleoside analogues. However, less than 50% of patients achieve the “efficacy triple endpoint” and, after subtracting more than 5% of relapses, only 5-8% of patients with sustained efficacy achieve surface antigen/antibody conversion. The ability to mount an adequate immune response is highly variable and can only be achieved on an “ad hoc” basis. Calling surface antigen/antibody conversion a “gold medal” is harmful marketing hype, and blindly prolonging the course of treatment can achieve very little, not only in terms of waste, mental and physical exertion, but also in terms of uncertain safety risks.