The concept that the most fundamental treatment for viral hepatitis B (hepatitis B for short) is antiviral has been accepted by most patients, but there are still some misinformation among some patients, especially on the Internet, which affects their determination to receive antiviral treatment, and some even delay their disease as a result. For these patients, it is more important to clear the confusion. A. “Normal aminotransferases do not need or can not be antiviral treatment” Clinical experience has found that aminotransferases (alanine aminotransferase, ALT, formerly known as glutamate aminotransferase, GPT) significantly abnormal antiviral treatment is more effective, therefore, China and some other countries and regions of the prevention and treatment of hepatitis B, diagnosis and treatment guidelines are to ALT ALT is more than 2 times the upper limit of normal as an indication for antiviral treatment. However, ALT is not the only sensitive indicator of liver tissue damage, and a large body of literature shows that a significant proportion of hepatitis B virus-infected patients with normal or mildly elevated ALT have varying degrees of inflammatory necrosis and/or fibrosis in the liver tissue, some of which can be moderate or above (RG2S2), and a few have histological manifestations of cirrhosis. Recently, an American scholar pooled and analyzed the liver pathology of 830 ALT-normal hepatitis B virus-infected patients from 9 studies published in international medical journals, and showed that 20.7% had significant fibrosis (RS2), and the percentage was higher in the 30-40 age group, and even after lowering the upper limit of normal ALT to 30u/L for men and 19u/L for women, the percentage of significant fibrosis in this group was still as high as 27.8%. Even if the upper limit of normal ALT was lowered to 30u/L for men and 19u/L for women, the percentage of significant liver fibrosis in this group was still as high as 27.8%. The 2010 edition of the “Guidelines for the Prevention and Treatment of Chronic Hepatitis B” suggests, based on a large body of evidence-based medical data, that ALTQ2 times the upper limit of normal, but with histological liver inflammation and necrosis RG2 or fibrosis RS2, is also an indication for antiviral therapy. Antiviral therapy should also be considered in those with ALT greater than the upper limit of normal (but less than 2-fold) and aged 40 years; in chronic hepatitis B carriers with ALT below normal or mildly elevated and evidence of disease progression (e.g., splenomegaly) found during follow-up observation, liver histology is recommended and antiviral therapy is given if necessary; in those with persistently normal ALT but aged 40 years, it is advisable to perform liver biopsy, especially for men or those with a family history of liver cancer, then regardless of normal or mildly elevated ALT, liver histology is strongly recommended to clarify the degree of liver damage and determine whether to administer antiviral therapy. As for patients with post-hepatitis B cirrhosis, regardless of whether their ALT is normal or not, as long as the HBVDNA is high (compensated cirrhosis) or detectable (decompensated cirrhosis), antiviral therapy with nucleoside (acid) analogs should be used (interferon should be used with caution in compensated cirrhosis and contraindicated in decompensated cirrhosis). As can be seen, whether ALT is abnormal is an important indicator of antiviral treatment for chronic hepatitis B, but it is not the only indicator. It needs to be analyzed based on the patient’s overall condition, past medical history, as well as age, gender and even family history, etc. If necessary, liver histological examination should be performed to clarify the degree of liver tissue damage, and then individualized treatment plans should be adopted to avoid delaying the timing of treatment. The statement that “people with normal transaminases do not need antiviral treatment” is not comprehensive. It is true that the antiviral drugs currently used, especially the nucleoside (acid) analogues, will be resistant to some patients during the treatment process, as shown by the virus that has been suppressed is active again, HBVDNA quantification rises again, thus leading to the benefit of antiviral treatment again. This is indeed a problem that should be taken very seriously. The incidence of drug resistance varies from drug to drug, with some drugs having a low incidence of resistance due to their high resistance gene barrier, such as drugs used for 5-6 years. The incidence of drug resistance is only 1.2% for 5-6 years; 2. Most drug resistance can be prevented by strictly selecting the indications before using drugs and not using drugs blindly; when available, try to use drugs with strong antiviral effects and high resistance gene barrier; maintain good compliance in treatment, strictly follow the regulations of medication, avoid stopping drugs at will, intermittent medication or repeatedly changing drugs within a short period of time; 3. After drug resistance occurs, salvage treatment can be carried out – adding drugs with resistance genes different from those of the original drug used can still achieve better therapeutic results, and the key is to review regularly during treatment to detect drug resistance in a timely manner. Therefore, although the risk of drug resistance must be taken very seriously by both doctors and patients, the benefits of most patients with chronic hepatitis B are significantly greater than the risk of drug resistance compared to the benefits of antiviral therapy, and it is obviously not wise to give up treatment for fear of drug resistance. As the currently used antiviral drugs do not directly kill the hepatitis B virus but mainly inhibit its replication, and ultimately rely on the body’s own immune mechanism to clear the virus, which is a rather long process, antiviral drugs, especially nucleoside (acid) analogues, must be used for a long time. However, “long-term use” is not the same as “lifelong use”, of which interferon has a relatively fixed course of treatment, generally 6-12 months, while the use of nucleoside (acid) analogues, after reaching certain indicators can also be considered to discontinue observation, China In 2010, the “guideline” opinion is: the original e antigen-positive (commonly known as major triple-positive) patients with slow hepatitis B, after treatment with normal liver function, HBVDNA below the detection value, e antigen e antibody serology conversion, continue treatment for 1 year, and at least every 6 months to test the above indicators remain unchanged, the total course of treatment for at least 2 years, can be For those who are e antigen-negative and e antibody-positive (commonly known as minor triplets), continue treatment for 1.5 years after liver function has returned to normal and HBVDNA is lower than the detection value, with the above indicators remaining unchanged every 6 months and the total course of treatment reaching at least 2.5 years, you can also consider stopping the drug, as the relapse rate of such patients is higher after stopping the drug, you can extend the course of treatment. According to the guidelines, many patients with chronic hepatitis B have successfully discontinued their medication and a significant number have not relapsed after long-term follow-up. However, for most patients, even with nucleoside (acid) analogs, the course of treatment may be limited, and not all patients need “lifelong medication”, except for patients with post-hepatitis B cirrhosis and hepatitis B-related liver cancer, for whom the course of antiviral therapy needs to be longer. However, patients with post-hepatitis B cirrhosis and hepatitis B-related hepatocellular carcinoma require longer courses of antiviral therapy. The use of antiviral drugs has proven to be a tremendous advance in the treatment of hepatitis B for more than a decade, and a large number of patients have benefited from it: the hepatitis B virus is continuously suppressed, liver inflammation is controlled, health status is significantly improved, liver fibrosis (including cirrhosis) is stable or reduced, and some patients have reached the desired endpoint of surface antigen to surface antibody conversion; the proportion of hepatitis B-associated liver cancer in the overall liver cancer has begun to decline. Some of the difficulties and factors affecting antiviral therapy are also being addressed through increased research. Therefore, it is important not to blindly use antiviral drugs without selecting indications, but also to avoid being worried when treatment is indicated, and to avoid being influenced by “pseudo-health” rumors that may shake the determination to receive treatment.