Drug resistance has become the biggest challenge in the field of hepatitis B treatment, and statistics show that more than 100,000 hepatitis B patients in China are currently experiencing drug resistance during treatment. Once drug resistance occurs, the ability of antiviral drugs to inhibit viral replication is greatly reduced, causing recurrence of the disease, while cross-resistance between drugs can also make follow-up treatment difficult. The director of the Institute of Liver Diseases at the city’s fifth hospital, Tong Fuyi, believes that it is best for chronic hepatitis B patients to choose an antiviral drug that is both potent and low in resistance for their first treatment. The first time a patient is treated with an antiviral drug, it is best to choose one that is both strong and low in resistance. “The problem of drug resistance is plaguing many hepatitis B patients and also making hepatitis B treatment challenging. The drug resistance not only makes the patient physically “injured” again, but also psychologically burdensome. Many patients suffer from loss of appetite, anxiety and insomnia. Severe negative emotions can further lead to aggravation of the patient’s condition and enter a vicious circle. According to the survey, the incidence of psychological problems in such patients is close to 100%, with the highest incidence being anxiety. Patients are very worried about disease recurrence: 63.3% of patients are worried about disease transmission to family members, 60% of patients are worried about reduced work capacity, 38.3% are worried about the financial burden on the family caused by long-term treatment, 30% are worried about dragging down their families, and 26.7% are worried about being kept away from people because of infectious diseases. Since drug resistance can make the virus rebound and aggravate the disease, it makes it impossible for patients to study, work, marry or have children, which casts a shadow not only on patients but also on their families. When drug resistance occurs, it can increase the cost of treatment significantly, placing an even heavier financial and psychological burden on the patient and his or her family. Virus mutation causes Drug resistance is a gradual process, said Tong Fuyi, director of the Institute of Liver Diseases of the Fifth Hospital, the virus resistance mainly occurs in the process of nucleoside (acid) drugs to treat chronic hepatitis B. At first, there may be only a small number of mutated virus strains in the patient’s body. Although these viruses are resistant to drugs, they are less capable of replicating than wild strains of virus. Therefore, the wild strain remains “dominant” in the body. With the use of antiviral drugs, the drug-sensitive wild strains are beaten to death, while the drug-resistant mutant strains “escape” the drug attack by virtue of their resistance and are given the opportunity to replicate and become the “dominant” strain in the body. The “dominant” strain becomes the “dominant” strain in the body. At this point, the patient’s liver function will rebound, leading to clinical resistance. Viral genetic mutations are widespread in nature and can also be induced by drugs. Therefore, from this perspective, it is inevitable that viral mutations will occur during treatment. “The actual fact is that it is not a catastrophe, as long as you actively deal with it, you can minimize the risk of drug resistance problems,” said Tong Fuyi. Once drug resistance occurs, the patient must inform the specialist, who will select those drugs for the patient that have not yet developed resistance based on the results of the genetic sequencing of the drug-resistant virus. The actual fact is that you will need to have regular checkups What is drug resistance? The actual fact is that if a patient has a good treatment, the serum hepatitis B virus DNA was once suppressed, and the viral load dropped significantly, but the viral load slowly rose again during the continuation of treatment, and rose more than 10 times compared to the lowest value of the drop, and confirmed by re-examination, this means that viral resistance occurred, which is medically called virological breakthrough. It is understood that if the viral load suddenly rises by more than two orders of magnitude or above the pre-treatment level, this is called a viral rebound. If the viral load rises slowly while the serum transaminase level rises above normal, this indicates that viral replication is increasing while inflammation of the liver is occurring, which is medically known as a biochemical breakthrough. During the treatment period, drug resistance needs to be observed periodically. Generally, the interval between examinations is three months to six months, with the main laboratory tests checking serum hepatitis B virus DNA levels, drug resistance gene sequences and liver function. At present, the city’s five hospitals can use PCR amplification of hepatitis B virus DNA polymutase gene sequence analysis and other methods, can detect hepatitis B virus drug resistance gene. There are rules for medication “In order to prevent the occurrence of drug resistance, treatment must be chosen by a specialist”, Tong Fuyi introduced, treatment begins with the use of strong antiviral drugs that rapidly and consistently suppress viral load to unmeasurable levels. The incidence of viral resistance is closely related to the degree of viral suppression, and the first step in reducing the incidence of drug resistance is to reduce the amount of virus in the blood, or to lower the viral load as much as possible. The lower the viral replication, the less likely it is that mutations will occur, and the lower the incidence of drug resistance will be. It is also critical to select antiviral drugs with a high resistance genetic barrier. The “resistance gene barrier” is like a wall. The chance of mutation at one locus is about 1 in 50,000, while the chance of mutation at three loci at the same time is about 1 in 10 million. Initial treatment should choose drugs with strong antiviral activity and low drug resistance, which has been the international medical consensus for the treatment of chronic hepatitis B today. In addition, during treatment, if antiviral therapy is not effective for 3 to 6 months, you need to consider timely adjustment of the regimen and change to other drug therapy; do not use lamivudine for a period of time and then switch to adefovir, and then to entecavir after a period of time; do not blindly combine drugs. Before treatment, patients should understand the whole process of treatment, master the precautions during treatment, and do not discontinue at will.