Anti-virus is the key to hepatitis B treatment. On this thorny journey, hepatitis B patients need to go through various trials and tribulations. In order to fight the virus with half the effort, hepatitis B patients can create a treatment memo, record the code of antiviral in the book, to remind themselves not to take the wrong path, fork in the road, and under the guidance of doctors to carry out scientific and effective antiviral treatment. Code 1: Figure out the timing of antiviral Anti-viral is about timing, not all people infected with hepatitis B virus need treatment. Even if the HBV DNA level is high in hepatitis B virus carriers, as long as the liver function is normal, there is no need for antiviral treatment. However, it is important to insist on regular testing and not to take it lightly. According to the latest “Expert Consensus on Antiviral Therapy for Chronic Hepatitis B” published in 2010, patients with HBV DNA levels above 1×104 copies/ml and/or serum ALT levels above the upper limit of normal, and liver biopsies showing severe to severe active inflammation, necrosis and/or liver fibrosis need antiviral therapy. In addition, patients with liver biopsies showing severe to severe active inflammation, necrosis and/or fibrosis should also begin antiviral therapy immediately. Code 2: Adhere to long-term antiviral therapy The hepatitis B virus is so resilient that no drug has yet been able to completely eradicate it. Both interferon and nucleoside (acid) analogues can only inhibit the replication of hepatitis B virus, and after short-term treatment (≤1 year) is stopped, the patient’s HBV DNA level will rebound significantly, which shows that hepatitis B treatment requires “long-term treatment” in order to “long-term security”. For the course of nucleoside (acid) analogues, the Chinese Hepatitis B Prevention and Control Guidelines recommend that: after 1 year of treatment, if HBV DNA levels turn negative and liver function is normal and serological conversion is achieved in patients with major hepatitis B, then consolidation therapy is required for another 12 months; after 1 year of treatment, if HBV DNA levels turn negative and liver function is normal in patients with minor hepatitis B, then consolidation therapy is required for another 18 months. In short, patients with hepatitis B must adhere to oral antiviral therapy for at least two or two and a half years before they can scientifically discontinue it. Code 3: Regular monitoring and follow-up Both hepatitis B carriers and hepatitis B patients need regular monitoring and follow-up, which carries out three major functions that should not be ignored. First, regular monitoring can determine the progress of the disease. Hepatitis B carriers can rely on it to decide whether antiviral is needed, while hepatitis patients who are taking medication can learn about the progress of the disease to prevent the development of cirrhosis and liver cancer. Second, monitoring allows early detection of drug side effects and timely intervention to prevent medical errors. In addition to routine tests, patients with hepatitis B have to add monitoring items according to the characteristics of certain types of drugs, such as CK levels, creatinine, etc. Third, the monitoring results are also a litmus test for the efficacy of the treatment. If the results are not good, the doctor can adjust the treatment plan according to the patient’s condition in time. Therefore, patients need to actively cooperate with the doctor, do regular monitoring and follow-up, every three months to monitor HBV DNA levels, liver function, hepatitis B five, etc. Code 4: The selection of drugs to comply with the “three less” principle Hepatitis B oral antiviral treatment requires long-term treatment, the selection of drugs to comply with the “three less” principle: less cirrhosis, liver cancer; less adverse reactions and less cost. After full communication with the doctor, patients with hepatitis B need to consider these three factors and choose the most suitable antiviral drugs for themselves. Reducing cirrhosis and liver cancer, thus prolonging life and improving quality of life is the ultimate goal of hepatitis B treatment. The landmark 4006 three-year study in the field of hepatitis B treatment found that 3 years of treatment with a nucleoside analogue (lamivudine) reduced disease progression by 55% and the occurrence of liver cancer by 51%. In addition, the 10-year follow-up data from the 4006 study showed that adherence to long-term oral antiviral therapy not only resulted in significant improvement in liver fibrosis, but even reversed early cirrhosis in individual patients. The four major nucleoside (acid) analogues currently available in China are all safe and adverse effects are relatively rare. However, as the population expands during treatment, combined medications and individual differences emerge, the side effects of the drugs are showing their “fox tails. Since hepatitis B treatment requires at least 2-3 years of adherence, hepatitis B patients should try to choose drugs that have been available for a long time, are widely used by the population, and have few adverse effects for safety reasons. Although nucleoside (acid) analogs are in the national medical insurance catalog, which saves some money for hepatitis B patients, the reimbursement rate of medical insurance is still linked to the price of the drug, plus testing fees, outpatient fees, other liver-protective drugs, and lost wages, the annual cost is still high. Therefore, hepatitis B patients must first weigh their pockets when choosing drugs, and choose drugs that they can adhere to for at least 2-3 years. Don’t just follow the trend of choosing new high-priced drugs, which may accelerate the deterioration of the disease due to the shortage of funds for reducing the dosage and stopping the medication during the treatment. Code 5: Optimize treatment and prevent drug resistance A number of clinical trials at home and abroad have confirmed that six months (24 weeks) is a critical time point in the oral antiviral process. At this time, according to the test results, the treatment can be optimized to prevent the occurrence of drug resistance. If a patient’s HBV DNA is less than 3 times 10 at the beginning of six months (24 weeks) of treatment, it means that the efficacy is very satisfactory and monotherapy can be continued. If, after six months of treatment, the patient’s HBV DNA level has decreased but is still greater than 3 times 10, it indicates that the efficacy is not very satisfactory and drug resistance may occur in the long term, requiring adjustment of the treatment regimen. More and more doctors around the world are now recommending combination therapy with a drug that does not have cross-resistance sites, such as lamivudine in combination with adefovir (tipifudin or entecavir are treated in a similar way), while maintaining the original monotherapy. Combination therapy not only improves hepatitis B virus suppression, but also reduces the incidence of drug resistance and improves the patient’s treatment outcome. Patients with hepatitis B do not need to worry too much about drug resistance, which can now be prevented by optimizing treatment.