The incidence of various types of liver diseases is very high in China. The lack of proper understanding of liver disease has caused great mental stress and panic among many patients, and the society also discriminates against liver disease patients, which interferes with people’s order of life and health. Therefore, it is necessary to strengthen the basic knowledge education for patients and various groups in the society. Are all patients with liver disease contagious? Liver disease is a general term for damage to liver tissue cells caused by various causes. Currently, the common causes of liver disease are viral, alcoholic, drug, toxic, immune, vascular, metabolic, hereditary, bacterial, etc. Only viral liver disease is somewhat contagious. Among viral hepatitis, hepatitis A and E are transmitted through the digestive tract (mouth), while other viral hepatitis such as hepatitis B and C are transmitted mainly through blood or mother-to-child transmission, not through general life contact. Many couples where one partner is a hepatitis B patient have lived together for decades and have not transmitted to the other partner. According to epidemiological surveys, 90% of people with chronic hepatitis B virus infection in China are infected before the age of 5, and 80% are infected before the age of 1. Ninety-five percent of those infected with the hepatitis B virus in adulthood can be self-cured or cured. Is hepatitis B hereditary? Many patients think they are hereditary because their mother and or father carry the hepatitis B virus or have hepatitis B. This is actually a misconception. Hereditary diseases are caused by chromosomal abnormalities in the predecessor’s own genes, resulting in genetic abnormalities in the offspring, while hepatitis B is a disease caused by infection with an exogenous pathogen, the virus, and there is a fundamental difference between the two. Viral infection is a preventable and curable infectious disease. Your hepatitis B virus will not be “passed on” to your child. (Note: Mother-to-child transmission and father-to-child transmission are actually internal transmission of the hepatitis B virus from parents to the next generation, which is not “inherited. Currently, many advertisements claim that “all five hepatitis B items have turned negative” with the use of drugs, but it is very difficult to achieve such a goal. Currently, our goal for antiviral treatment is: negative HBVDNA, negative HBeAg, positive HBeAb, and normal liver function. The chance of surface antigen conversion is rare and cannot be considered as the end goal of treatment. Antiviral therapy is a long-term project, and according to current treatment experience, the course of either treatment regimen should be greater than 1 year, and the course of nucleoside (acid) drugs should generally last more than 3 years. How to stop the medication and when to stop it should be done under the guidance of a specialist. When should a patient with chronic hepatitis B be treated with antiviral therapy? Any antiviral drug has an indication for use, as detailed in the “Guidelines for the Prevention and Treatment of Chronic Hepatitis B” published in December 2005. A good timing of treatment will yield twice the result with half the effort, while a poor timing will result in a lot of work and expense. The basic principle is that the carrier with normal liver function and no lesions observed by ultrasound is not suitable for antiviral therapy; HBVDNA positive and ALT more than twice the upper limit of the normal value can be considered for antiviral therapy; antiviral therapy should be used for patients with cirrhosis regardless of their liver function, and the specific plan depends on the condition. How to prevent hepatitis B virus infection? The most effective preventive measure is vaccination against hepatitis B. Hepatitis B vaccination within 24 hours (preferably 12 hours) of birth can effectively prevent hepatitis B virus infection with a protection rate of 98% or more. Hepatitis B immunoglobulin and hepatitis B vaccine should be given to newborns of surface antigen-positive pregnant women within 24 hours at different sites, and it is not recommended to give hepatitis B immunoglobulin to pregnant women later in pregnancy. Children should be checked for HBsAb 3 to 5 years and attention should be paid to timely boosting of hepatitis B vaccination. Adults with close contact with hepatitis B virus, especially those with blood contact, should receive a high dose of hepatitis B vaccine (20 micrograms). Appendix: How does “major triple-positive” become “minor triple-positive”? When the immune function of the body of a patient with “major triple-positive” is activated, the immune system recognizes the antigenic material of the hepatitis B virus and the virus-infected liver cells and reacts to clear the virus, which is a self-protective reaction of the body. As a result, a large amount of virus is cleared while the infected hepatocytes are also destroyed, resulting in elevated transaminases and sometimes elevated bilirubin (i.e., jaundice). However, this clearance is often incomplete, and the non-replicating virus is often not killed and remains latent. When the body’s immunity decreases, the virus starts to replicate again, infecting new liver cells and leading to a new round of immune attack. This repeated process of clearance, destruction, re-clearing and re-destruction is how chronic hepatitis develops. As the virus is cleared from the blood, anti-HBe appears in the serum, HBeAg disappears, and the disease changes from “major triple-positive” to “minor triple-positive”. As you can see, the change from “major triple positive” to “minor triple positive” is a symbol of the decline in viral replication in most hepatitis B patients (except for those infected with mutated viruses) and a decrease in the number of viruses, sometimes even undetectable in the blood. Although “major” or “minor” hepatitis B does not directly correlate with the severity of liver damage, there are fewer infected hepatocytes and less immune response and liver damage when the virus decreases, so we always hope that the treatment will turn the “major” hepatitis B into “minor” hepatitis B. Therefore, we always hope to turn “major triple-positive” into “minor triple-positive” in treatment, so that the virus replication can be reduced to the lowest level, which is beneficial to the patient.