Anti-viral treatment for chronic hepatitis B is a long-term process and will not be achieved in a handful of cases, so prevention of drug resistance is a very critical issue. The following are a few comments for patients on this issue. A, the harm of drug resistance Some scientific research data show that: drug resistance will make the already obtained efficacy lost; will increase the difficulty of follow-up treatment; will certainly increase the economic burden of patients; and in terms of long-term benefits, may also increase the proportion of cirrhosis and liver cancer occurrence. Therefore, it is very important to prevent drug resistance. Several principles of drug resistance prevention 1. When the initial antiviral treatment is carried out, we should choose the appropriate drugs according to different situations, that is to say, the prevention of drug resistance should be prevented from the beginning of treatment! The following factors should be considered in the initial selection of drugs: (1) Patients who are E antigen-positive (major triple-positive) should not choose adefovir-based drugs because of their weak antiviral effect. (2), Lamivudine should not be chosen for those whose virus is above the 7th power of 10! Instead, you can choose entecavir or telbivudine depending on the patient’s situation. (3), the viral load is above the 6th power of 10, and the ALT does not reach more than 3 times the normal value should not choose alpha interferon drugs (not to consider the occurrence of drug resistance, but to consider the poor effect). 2, to the antiviral effect of the stage assessment, should not choose an antiviral drugs, a service to the end, because in different treatment stages required to achieve the therapeutic goals are not the same! For example, if a nucleoside (acid) analogue is chosen for the initial treatment, the efficacy should be evaluated at 3 and 6 months after treatment. If the viral load decreases less than one times at 3 months and less than two times at 6 months, it is called primary non-response and poor response, respectively, and it is necessary to find out the cause and, if necessary, change the drug or add a drug that is not cross-resistant with the drug used. Even DNA sequence measurement is needed to determine the presence of primary drug resistance and secondary drug resistance caused by previous medication. 3. For patients with major triplets, the goal of treatment is usually seroconversion of antigens. The duration of disease in such patients is shorter than in those with E antigen negativity, and after reaching the goal, there is every possibility of stopping the drug (relapse is possible after 5 or 6 years, and re-treatment is more likely to achieve efficacy than the initial treatment). If the original use of nucleoside (acid) drugs other than entecavir, to consider timely adjustment of treatment regimen (add or change drugs). 4, for E antigen negative slow hepatitis B, the satisfactory goal of treatment is normal ALT, HBV-DNA negative, usually 3 months of treatment can be effective, but must be maintained for a long time, otherwise, once the drug is stopped, will soon relapse. And its best goal when the surface antigen negative, this goal can be achieved by a small number of patients, but generally to use the combination of long-acting interferon and nucleoside analogues, and ask your doctor to choose an effective target population will have greater hope. 5, the choice of alpha interferon alone, will not occur resistance problems, but the treatment effect is also predictable: the general prediction point at 32 weeks of treatment, if HBV-DNA decline less than 2 times, even if the use of 48 weeks of effect will not be good, should promptly adjust the treatment plan. 6, prevention of drug resistance to move forward: the first gateway to the prevention of drug resistance is the initial treatment; the second gateway is the occurrence of genetic resistance; the third gateway DNA quantification has rebounded (1 times higher than the lowest value after treatment), or even breakthrough (1 times higher than the level before treatment); the fourth gateway is the occurrence of clinical resistance, that is, not only the DNA level is elevated, and the patient ALT levels have also changed from normal to abnormal. We better hold the first gate. At least the second gate! Therefore, if you visit a medical unit that can only perform liver function and hepatitis B five tests, patients should take the initiative to be able to check the HBV-NDA unit for a supplemental test, in addition, to dynamically observe the HBV-DNA level, and if necessary, genetic resistance testing. 7, patients should maintain good compliance: stopping medication without reaching treatment goals is inevitable for recurrent disease! There is also scientific research data that shows that drug resistance has a lot to do with patient compliance. The patients with poor compliance are the ones who take their medication for three days and the ones who stop intermittently are the most prone to drug resistance! The nucleoside and nucleotide analogues are currently on the market. Among the several nucleoside (acid) analogues, entecavir is a strong low resistance drug; telbivudine is a strong medium resistance drug; lamivudine is a medium high resistance drug; and adefovir is a low medium resistance drug. alpha interferon is generally not resistant, but its antiviral effect is weaker than that of the nucleoside (acid) analogues, and has a stronger The first of these is a new one. The first thing you need to do is to get a good idea of what you are getting into. With the correct use of salvage therapy, the vast majority (95%) of patients can also achieve good results in controlling disease progression. At present, the antiviral treatment for hepatitis B has made great progress, and many patients in China have already achieved clinical recovery using the drugs currently available! It is worth mentioning that the European Liver Conference held in London, England, in April this year, broke new and welcome news: therapeutic drugs are being researched, and this stubborn viral disease of hepatitis B may be overcome in a few years! So patients suffering from chronic hepatitis B, don’t be sad, don’t be depressed, even if only the current treatment is available, as long as the active and correct treatment is taken, it is perfectly possible is to make the patient maintain the quality of life of a normal person, without affecting marriage, childbirth, life expectancy! It is even possible to reverse the disease in patients with early (or even late) stage cirrhosis! Patients and doctors work together! The light is just around the corner!