Today, I received a letter from a netizen who said that he had been treated with antiviral therapy for chronic hepatitis B for three years with very good results. Recently, he suddenly read on the Internet that a hepatitis B patient developed liver cancer in the course of antiviral treatment, and remembering that his father also died of liver cancer, he was very scared and had doubts about the effectiveness of his antiviral treatment. Then, why would hepatocellular carcinoma occur in hepatitis B patients after antiviral treatment? Is it because the antiviral drugs have not improved the damage caused by the hepatitis B virus to the liver? To clarify this question, we must first look at who is responsible for the progression of hepatitis B disease? In one study, patients were categorized into three groups of ≥105, 104 and <104 copies/ml according to their initially detected HBV DNA (baseline HBV DNA) levels, and the incidence of hepatocellular carcinoma in these patients was observed 13 years later (Figure 1). It was found that patients with higher HBV DNA levels had a higher chance of developing liver cancer in the future. Figure 1, Cumulative incidence of hepatocellular carcinoma in patients with different baseline HBV DNA levels after 13 years of follow-up In another study, patients were divided into five groups according to their initially detected HBV DNA (baseline HBV DNA) levels: ≥106, 105 to <106, 104 to <105, 300 to <104 and <300 copies/ml, and it was observed that how many of each of these patients in each of the groups after 13 years had developed cirrhosis (Figure 2). The results similarly found that the outcome of hepatitis B was related to viral replication, and the higher the HBV DNA, the higher the chance of developing cirrhosis in the future. It appears that viral replication is responsible for disease progression. Figure 2, Incidence of cirrhosis after 13 years of untreated baseline HBV DNA levels Later, the researchers subdivided these patients into two groups of those with abnormal ALT and those with normal ALT according to the different HBV DNA levels, and observed their incidence of cirrhosis after 13 years (Figure 3). It was found that those with abnormal liver function and high HBV DNA were more likely to develop cirrhosis than those with normal liver function. Figure 3, the relationship between the outcome of hepatitis B and viral replication and ALT abnormality The above results fully indicate that hepatitis B virus replication is the culprit of hepatitis B disease progression. Only by effectively suppressing viral replication with antiviral drugs can the disease progression of chronic hepatitis B be stopped, and those with abnormal liver function are more in need of effective antiviral treatment. In a study of lamivudine treatment for hepatitis B cirrhosis in China, 436 people were treated with lamivudine and 215 people were treated with placebo. 3 years later, 21% of the patients treated with placebo had progression of the disease, and died of liver failure, hepatocellular carcinoma, spontaneous peritonitis, or gastrointestinal hemorrhage, while only 9% of the patients treated with lamivudine had progression of the disease (see Figure 4). If lamivudine resistance did not occur during treatment, the incidence of liver disease progression was even lower, at 5%; even when lamivudine resistance occurred, the incidence of liver disease progression (13%) was lower than that of patients in the placebo group without antiviral therapy (see Figure 5). Fig. 4. Results of the study of lamivudine treatment of cirrhosis in China (1) Fig. 5. Results of the study of lamivudine treatment of cirrhosis in China (2) The above results fully demonstrate that although antiviral treatment cannot completely block the occurrence of liver cancer and its complications, antiviral treatment significantly reduces the occurrence of liver cancer and its complications and improves the prognosis of hepatitis B disease. As a result of the application of antiviral therapy in the past few years, the death rate of hepatitis B patients has been greatly reduced, and their lives have been greatly improved, and most of the hepatitis B patients can take a pill and work, study, get married, and give birth normally. Therefore, don't lose confidence in your treatment because of liver cancer that occurred in individual patients. Adherence to treatment is victory!