How to choose antiviral drugs for slow hepatitis B Currently there are two major classes of drugs for antiviral treatment of patients with slow hepatitis B in China: interferons and nucleoside (acid) analogs. Different drugs have different indications and different patients have different needs, so it is necessary to choose the drugs according to the condition of different patients and combine them with their treatment needs. In general, those who are younger than 40 years old, have low HBVDNA viral index values, high ALT values in liver function (500 U/ML or more), no substantial liver damage, and no other intercurrent diseases are preferred to interferon therapy. The rest can be considered for oral treatment with nucleoside analogues, with the aim of being able to control the progression of the disease and guarantee the quality of life. However, it should be emphasized here that you must see your physician to make a choice of antiviral treatment and let a senior physician make the choice for you. The higher the virus of hepatitis B virus infection the more antiviral treatment should be given This view is incorrect, because hepatitis B virus infection can be divided into four stages: 1, the immune tolerance period, when most of the two pairs of half performance HBeAg positive, and HBsAg, HBeAg, HBVDNA values are very high, liver function is basically normal, clinically no symptoms. Medically, these people are called hepatitis B virus carriers and do not need antiviral treatment. 2.Immune clearance period, the liver function is abnormal and some symptoms related to liver disease will appear clinically, at this time we can diagnose as chronic hepatitis B patients and need to choose the appropriate antiviral treatment plan. 3.Immune control period, this period of patients is characterized by basically normal liver function, high HBsAg values, but the values of HBeAg and HBVDNA can be to the extent of undetectable, these patients do not need treatment, but should be observed, characterized by the situation about liver tumors. 4, immune escape period, this period of the patient’s virus and re-positive, whether to be treated according to liver function, liver damage and a series of comprehensive considerations before deciding. For chronic hepatitis B patients, why is the first antiviral treatment? As we all know, chronic hepatitis B is a disease caused by people infected with the hepatitis B virus, so only when we destroy or control the virus in the body, can people’s disease be controlled, so that the body can return to normal, to achieve the effectiveness of the cure. Therefore, once a person infected with the hepatitis B virus evolves into a person with hepatitis B, we should give priority to antiviral treatment to get twice the result with half the effort. What are the current drugs available for antiviral therapy for patients with chronic hepatitis B? Up to now, there are 2 kinds of interferon and 5 kinds of oral nucleoside (acid) analogs approved for anti-hepatitis B virus drugs in China. 1, interferon is divided into ordinary interferon and long-acting interferon. There are 2 types of long-acting interferons, Pyroxin was used earlier in hepatitis B and Pellegrin was approved for the treatment of slow hepatitis B only in 2007. 2. Nucleoside (acid) analogues include lamivudine, adefovir, entecavir, tipifudine and tenofovir. Other than these, there are no other approved drugs that can fight the hepatitis B virus, so patients should not listen to hearsay. What are the advantages and disadvantages of each of the two classes of antivirals? Nucleoside (acid) analogs have a direct inhibitory effect on viral replication, while interferon also has a direct antiviral effect, but is primarily an immunomodulatory agent, so each class of drug has its own characteristics. In terms of advantages, nucleoside (acid) analogs have a stronger effect in inhibiting viral replication and faster symptom control; interferon has a higher chance of converting “major triple yang” to “minor triple yang”, and is effective and stable, with fewer relapses. In terms of disadvantages, nucleoside (acid) analogs require long-term treatment and are prone to relapse after stopping, while long-term treatment has drug resistance problems; interferon does not have drug resistance problems and has a relatively limited course of treatment, but the injectable form is relatively inconvenient to use and has more adverse reactions, such as local injection pain, fever, headache and other flu-like symptoms. How to deal with abnormal ALT in liver function? The transaminases in liver function index include ALT and AST, which are mainly found in liver cells and reflect the health condition of liver. When liver cells are damaged by inflammation, necrosis, or poisoning, transaminases are released into the bloodstream, causing an increase in serum transaminases. Elevated aminotransferases are only a phenomenon and do not indicate the cause of the elevation, and they are not harmful to the body. Aminotransferase levels between 0 and 70 are normal. If it exceeds the normal range by less than 10 times and there are no obvious clinical symptoms, the doctor will suggest to review the liver function several times without medication for a while to dynamically observe the change of ALT and analyze the cause of ALT elevation. If, after 1 to 3 months of observation, the transaminase level continues to rise and there are positive viral indicators, an appropriate antiviral treatment program can be considered. Treatment of hepatitis B is completely possible without enzyme-lowering drugs. If it is caused by toxic factors such as drugs and alcohol, the treatment is based on treatment to reduce the burden on the liver, detoxify the liver and promote liver cell repair. If the elevated ALT is caused by immune dysfunction, then immunomodulatory treatment is the main treatment. In short, do not worry too much about the elevation of ALT and directly add simple enzyme-lowering drugs such as Wu Wei Zi and Baxinol. Because the effect of such enzyme-lowering drugs is to play a rapid cleavage effect on transaminases, not transaminases really do not exist, not to mention the reduction of liver inflammatory activity and the improvement of the disease, but rather mask the truth of the disease. It is safe and reliable only when the physician understands the cause of the disease and gives proper treatment from the root, while making the ALT gradually return to normal. Only then can we achieve our goal of liver preservation. However, if the value of transaminase rises to >2000UI/ml, i.e. more than ten times the normal value, or even dozens of times, especially when accompanied by obvious symptoms such as weakness and poor performance, we must pay great attention to it and immediately go to a specialized hospital to receive standardized treatment, so as to control the deterioration of the disease as early as possible, so as to avoid missing the “golden window” of treatment. In order to avoid missing the “golden window” of treatment and causing unnecessary human and material losses.