When can a nucleoside analog be discontinued? Discontinuation of nucleoside analogs is influenced by many factors and should not be done arbitrarily. According to the guideline, discontinuation of nucleoside analogs can be considered for patients with the following conditions: 1) “Triple Positive” before antiviral therapy, converted to “Minor Triple Positive” after taking nucleoside analogs, the virus is reduced to below the detection level, liver function is normal, and the disease remains unchanged after consolidation therapy for at least 3 years, and the total duration of therapy is at least 4 years. If the total duration of treatment is at least 4 years, the drug can be considered to be stopped. (2) If the patient is “small triple positive” before antiviral treatment, generally need to take medication for a long period of time. If the surface antigen disappears, and remains unchanged after 1.5 years of consolidated treatment, the patient can be considered to stop taking the medication. For patients who do not meet the above conditions, if they really want to stop taking the drug, they should be guided by a specialist and closely observed after stopping the drug. Normal liver function and e-antigen conversion (i.e. “triple positive” to “triple negative”) are indications for stopping the drug, but it does not mean that the drug can be stopped if the liver function is normal and the e-antigen is converted, because the antiviral mechanism of nucleoside analogs is to inhibit viral replication, and short-term normalization and e-antigen conversion are not enough to inhibit viral replication. Short-term normalization of liver function and e-antigen conversion do not indicate that the virus has been completely eliminated, so long-term consolidation of treatment and dynamic observation of disease changes are needed. Can I have children during antiviral treatment? During the course of antiviral treatment, if you are a woman, you should take the initiative to use contraception! After achieving the therapeutic goal and stopping the drug, if the drug used is α-interferon, it is necessary to stop the drug for 6 months before considering pregnancy; if the drug used is a nucleoside analog, it is possible to get pregnant 3 to 6 months after achieving the therapeutic goal and stopping the drug (the drug in the body has been completely cleared after three months). If the man is the patient, in the course of antiviral treatment, if the application of α-interferon (ordinary or long-acting), must wait for α-interferon discontinued 3 months before considering pregnancy. The reason why proposed to stop 3 months ~ half a year, and reproductive women are different (need to stop half a year is the drug instructions requirements), is to consider the short half-life of interferon, after stopping the drug 3 months, the body has no interferon; In addition, the fetus is conceived in the mother’s body, by the male side of the use of interferon caused by the likelihood of neonatal malformations is very small. If the male partner’s antiviral treatment uses nucleoside (acid) drugs such as telbivudine, tenofovir, entecavir, etc., the male partner can continue to maintain antiviral treatment. Is it better to take interferon or oral nucleoside analogs for antiviral treatment? The decision as to which drug is better to use is based on the specific condition of that patient as well as a combination of financial circumstances, medication history, and other conditions. Interferon Interferon not only has an antiviral effect, but also has an immunomodulatory effect, and its advantages are reflected in the relatively high e antigen serological conversion, that is, the common people say that the major triple yang into the minor triple yang, and the efficacy of the effective after the efficacy will be more long-lasting, but of course it has disadvantages, such as the need for injections, because the interferon class of drugs, including ordinary interferon, which is from the practical side of the consideration of the price of the ordinary interferon is not high. Who is interferon suitable for? General guidelines at home and abroad believe that if chronic hepatitis B patients have high aminotransferase levels, DNA levels are not very high, and the patient is relatively young, so that interferon therapy can first be considered, and it is possible to achieve better efficacy, and try to prioritize the consideration of long-acting interferon, in the hope that, through a limited course of treatment, such as a year, a year and a half, or two years, to be able to achieve the conversion of e-antigen serology, and the patient can be more stable after discontinuing the drug, which can avoid long-term medication, and the patient can be more stable. The patient can be stabilized after stopping the drug, and long-term medication can be avoided. Nucleoside analogues The most direct advantage of nucleoside analogues is that it is convenient to take orally, with fewer toxic side effects, and the antiviral efficacy is good, the HBV DNA decreases faster, and it is easy for people to see the immediate efficacy, but its shortcomings are also obvious, for example, it realizes the conversion of the e-antigen serology, and the proportion of the major triple positive to minor triple positive is small, and the relapse is more often after stopping the drug. Nucleoside analogs are suitable for which patients? Liver disease experts pointed out that, for example, patients who already have cirrhosis, especially those who already have ascites or gastrointestinal bleeding, can no longer tolerate interferon, the choice of oral antiviral drugs is very good. Therefore, the most important thing is to use the right medication, the two anti-hepatitis B virus drugs for different conditions have better efficacy, can not favor one of them. However, in view of the nucleoside drugs need to be taken for a long time, and may be drug resistant, and on the childless men and women whether there is reproductive toxicity is not clear, young patients preferred interferon treatment, from the use of the situation, patients over 40 years of age with active replication of the hepatitis B virus, the effect of interferon is indeed not very good. What should I do if I am resistant to antiviral drugs? The new version of “China’s chronic hepatitis B prevention and treatment guidelines” clearly pointed out that: some clinical studies have shown that, due to the occurrence of drug resistance to a nucleoside (acid) class and successively switch to other nucleoside (acid) class drug treatment, can be screened out to a variety of nucleoside (acid) class drug-resistant mutant strains. Therefore, single-drug sequential therapy should be avoided. Sequential treatment is what we usually call drug change, in the process of hepatitis B antiviral treatment, random drug change not only can not improve the efficacy, but also lead to drug resistance, this point is very important, and many patients with hepatitis B are not clear. Lamivudine, tibivudine, entecavir single drug resistance, plus adefovir is a good solution No matter what kind of drug is chosen by the first-time patients, once the drug resistance occurs, there is a corresponding solution. Lamivudine, telbivudine and entecavir all belong to the nucleoside class of drugs, all three have the same resistance site, therefore, if lamivudine resistance to switch to entecavir or telbivudine will lead to hepatitis B virus sensitivity to the drug decreases, not only is not conducive to the treatment of the disease, on the contrary, cross-resistance occurs, making it more difficult to treat. Studies have shown that switching to entecavir after lamivudine resistance results in a 51% resistance rate after 5 years. Another study shows that tibivudine is not effective in lamivudine-resistant patients, so it is wrong to switch to tibivudine for lamivudine resistance. Since adefovir has different resistance sites than lamivudine, entecavir, and telbivudine, the addition of adefovir after resistance to any of the three drugs is the preferred option to improve efficacy and reduce resistance rates. After adefovir resistance, the addition of adefovir is better than changing drugs Adefovir belongs to the nucleotide class of drugs, while lamivudine, telbivudine and entecavir belong to the nucleoside class of drugs, and the three have no cross-resistance sites with adefovir. Studies have shown that lamivudine and entecavir are effective against adefovir-resistant viruses. However, at this time, although the emergence of adefovir resistance, it is not recommended to stop adefovir, because the presence of adefovir will inhibit the emergence of viral resistance to lamivudine, which is the main reason why combination therapy can reduce the occurrence of drug resistance. It is worth noting that, as the treatment of chronic hepatitis B is a long-term process, patients should not only consider the efficacy of the addition of drugs, but also take into account the safety and cost-effectiveness, and which nucleoside analogues to add should be considered comprehensively from their own actual situation. Drug resistance can be prevented, do not have to wait until the drug resistance and then save The new guidelines recommend the optimization of treatment strategy emphasizes the importance of preventing drug resistance. That is, after the start of antiviral treatment, every 3 to 6 months to detect the level of hepatitis B virus, especially in the 24th week, if found that the hepatitis B virus did not turn negative, it is a sign of a greater likelihood of drug resistance in the future, and at this time the addition of drugs without cross-resistance sites can effectively prevent the occurrence of drug resistance, so as to ensure that hepatitis B treatment is effective in the long term and ultimately to achieve the purpose of delaying the progression of the disease and reducing the incidence of hepatocellular carcinoma. I am triple positive, what should I pay attention to with my spouse? Hepatitis B is mainly transmitted through blood, semen, and vaginal secretions when the infected person has wounds on the skin or mucous membranes. Of course, it can be transmitted through sexual intercourse. The best way to prevent it is to get vaccinated against Hepatitis B. It is best to wear a condom until antibodies are developed. Kissing is generally not contagious. However, if both partners have mouth ulcers, it is possible to get it from kissing or eating, or sharing toiletries. Daily life is generally not contagious. The hepatitis B virus is contagious when present intact in blood, semen, saliva, vaginal secretions, and other body fluids of a person with hepatitis B teratitis. If the healthy partner has mouth ulcers, broken oral mucosa, or caused other skin and mucous membrane breakage during coitus, the hepatitis B virus in the blood, semen, saliva, vaginal secretion and other body fluids of hepatitis B triple positive patients may enter into the bloodstream of the healthy partner through broken skin and mucous membrane, resulting in contagion. Therefore, it is possible for hepatitis B teratitis III to be infectious when sharing a room, but this infection can be blocked. The use of condoms during coitus can effectively block secretions with hepatitis B virus from staining wounds, thus avoiding the spread of hepatitis B virus. If the body produces sufficient amount of protective antibody, i.e. hepatitis B surface antibody, you will not be infected even if you don’t use a condom when having sex. Hepatitis B patients: When do I need to have a liver puncture? When hepatitis B patients have the following three conditions, they need to have liver puncture test to clarify the specific condition. 1. When hepatitis B patient’s e antigen is positive, hepatitis B virus DNA is positive, liver function is normal, and there are no obvious clinical symptoms, and it is uncertain whether he should receive treatment. This conclusion depends on the degree of inflammation of the patient’s liver tissue and the degree of liver fibrosis. To determine whether the patient’s liver has inflammatory changes and the degree of hepatic fibrosis, only blood tests and ultrasound examinations are insufficient, and only through liver biopsy pathology can the degree of liver lesions be clarified. Research has confirmed that about 50% of hepatitis B patients with normal liver function have different degrees of inflammatory changes after pathological diagnosis of liver biopsy, and some of them even have early cirrhosis. This situation shows that normal liver function does not mean that the liver must not have lesions. 2, when some patients who have achieved significant results in antiviral therapy after a period of consolidation of treatment, it is difficult to determine whether to stop the drug treatment, can be clarified through the liver biopsy pathology examination. Some patients with hepatitis B are most concerned about whether their antiviral treatment should continue for the rest of their lives. After receiving regular treatment, when the replication index of hepatitis B virus has turned negative after laboratory examination, the e antigen of hepatitis B virus has been converted into e antibody of hepatitis B virus, and the liver function of hepatitis B virus has been normal, immunohistochemistry examination can be carried out through liver biopsy to find out the situation of the core antigen of hepatitis B virus in the liver tissue. If the above test result shows that the core antigen of hepatitis B virus is negative, it means that the patient’s liver disease has been basically cured, and the antiviral treatment can be suspended, and the patient only needs to follow up closely to observe the changes of his condition. 3.For patients with unclear etiology, persistently elevated serum aminotransferases and jaundice, liver biopsy can be performed through liver biopsy to clarify the damage to the liver, and sometimes the cause of the disease can be clarified. How to prevent mother-to-child transmission? Currently, the medical profession advocates measures for some pregnant women with hepatitis B (Hepatitis B) to be treated aggressively and allowed to give birth naturally. After a pregnant woman suffers from hepatitis B, hepatitis B virus can enter the fetus through the placenta, and can also be transmitted to the baby through the birth canal delivery and amniotic fluid contamination and other ways. According to China’s statistics, the hepatitis B virus carrier rate among pregnant women is 6%~8%, if the baby is not given hepatitis B vaccine and hepatitis B immunoglobulin after birth, the mother-to-child transmission rate of hepatitis B virus is 20%~50%; if the mother is positive for hepatitis B e antigen, the transmission rate can reach 75%~95%. According to statistics, hepatitis B virus surface antigen ( HBsAg ) positive pregnant women born of infants, in the first three months after birth, about 70% of the blood HBsAg. As the immune system of infants and young children is not yet mature, incapable of clearing the invasion of the body of hepatitis B virus, once infected, easy to become asymptomatic carriers of hepatitis B virus or turn into chronic hepatitis. Pregnant women with hepatitis B transmit the hepatitis B virus to the next generation mainly through labor and delivery. The best way to avoid transmitting the hepatitis B virus to babies is to give newborns the hepatitis B vaccine + hepatitis B immunoglobulin (HBIG). Hepatitis B vaccine should be given to newborns within 24 hours of birth, at 1 month of age, and at 6 months of age, with a dose of 10 micrograms of yeast genetically engineered vaccine. The protection effect of hepatitis B vaccine for newborns can reach 90%. Alternatively, 200 international units of hepatitis B immunoglobulin (HBIG) can be injected into newborns within 6 hours of birth, and another 200 international units can be injected into newborns half a month later, and then hepatitis B vaccine can be injected into newborns at the age of 1, 2, and 7 months of age, and the protection effect of the vaccine can reach 95%. The above 2 methods can effectively prevent the transmission of hepatitis B virus during labor and delivery and postnatal close contact between mother and baby, but they cannot prevent the transmission of hepatitis B virus to the fetus through the placenta. In addition, since breast milk is not the main way of transmitting hepatitis B virus, and its risk is less than blood transmission, therefore, if the baby has been injected with HBIG and hepatitis B vaccine, breastfeeding can be carried out. What should I pay attention to in my diet for cirrhosis? Cirrhosis is a common chronic progressive liver disease that affects the metabolism of fats, etc., which can cause indigestion and other problems. As a result, patients with cirrhosis generally have a poor appetite and reduced digestive function. Proper arrangement of cirrhosis patient’s diet to ensure the patient’s reasonable nutrition is a step that cannot be ignored in the process of cirrhosis treatment. 1.Absolutely forbid alcohol and stimulating food, biliary cirrhosis should forbid fat and high cholesterol, when there is ascites, salt intake should be limited; when there is hepatic coma, protein should be forbidden; when there is esophageal varices, hard food should be avoided, and fluid or semi-fluid should be given; when there is upper gastrointestinal hemorrhage, fasting should be forbidden temporarily, and replenished by vein. In advanced cirrhosis with hepatic coma, protein intake should be strictly limited. Swelling or with ascites, should be less salt or no salt. 2, avoid eating eicosapentaenoic acid content of high fish digestive tract bleeding, is a common complication of liver cirrhosis patients and cause of death. Eating fish is often one of the factors that trigger bleeding. In the past, it was believed that the bleeding was due to fish spines breaking the varicose veins of the esophagus and the fundic veins. Currently, it seems that the alteration of coagulation function in the body as a result of the consumption of certain fish may be a more important cause. It has been reported that some fish contain a substance called eicosapentaenoic acid, an unsaturated organic acid, which is particularly abundant in fish oil. The human body cannot synthesize eicosapentaenoic acid from other foods and obtains it almost exclusively from fish. Eicosapentaenoic acid, one of the metabolites of prostacyclin, can inhibit platelet aggregation, and hepatic cirrhosis patients with coagulation factor generation disorders, platelet count was low, if eating fish containing eicosapentaenoic acid, platelet coagulation effect is reduced, it is easy to cause bleeding, bleeding is difficult to stop. The content of eicosapentaenoic acid in different fish varies greatly. Such as sardines, mackerel, swordfish and tuna, eicosapentaenoic acid content of up to 1 ~ 1.5%, while the true snapper, halibut, carp and other content is much less. So some patients with liver cirrhosis, in order to increase the body protein to eliminate ascites, eating carp soup, will not induce bleeding. The fish containing eicosapentaenoic acid should not be consumed. 3, avoid eating rough food The liver is an important organ of the human body, the abdominal cavity in the venous blood, almost all converge into a thick portal vein, through the liver flow back to the heart. When the liver undergoes hardening, a large amount of fibrous tissue proliferates in the liver, thus obstructing the venous return in the abdominal cavity, resulting in stagnation and elevated pressure in the portal vein. The blocked blood from the abdominal veins has to be detoured back to the heart through the lower esophageal veins. This large amount of blood flow through the lower esophageal veins causes the veins to dilate, thicken and protrude. The enlarged veins may protrude from the esophageal mucosa and become visible in the lumen of the esophagus, which is also called esophageal varices. Therefore, if you eat too rough, hard, in the passage of the esophagus, it is easy due to friction and damage to the veins, especially with bone spurs should be avoided, so as not to cut through the esophageal veins, resulting in rupture of the veins bleeding. About 20% of patients die from the first upper gastrointestinal bleeding. Once a patient suffers from esophageal vein rupture and bleeding, the situation is fierce, and if the rescue is not timely, it can be life-threatening. Therefore, patients with liver cirrhosis should pay special attention to soft, rotten, easy to digest. Green vegetables should be chopped and boiled before eating. In addition, eating should be chewed slowly, accompanied by esophageal varices, to prohibit food with bone spurs, while walnuts, peanuts and other nuts, hard nuts are not easy to chew food should be eaten with caution. Can sharing meals, shaking hands and kissing spread the hepatitis B virus? Hepatitis B virus is not transmitted through the gastrointestinal tract. Sharing meals and utensils is not contagious, and families do not need to share meals. Saliva containing the hepatitis B virus cannot infect orangutans by nasal or oral inoculation, so kissing does not generally spread. Daily work or life contact, such as working in the same office (including sharing computers and other office supplies), shaking hands, hugging, living in the same dormitory, eating in the same restaurant and sharing toilets and other non-blood exposure contact, generally will not transmit hepatitis B. Therefore, there is no need to talk about hepatitis B in general. Therefore, there is no need to talk about hepatitis B at all. Whether hepatitis B can be transmitted by blood-sucking insects (mosquitoes, bedbugs, etc.) has not been proven.