Hepatitis B treatment depends on the virus, aminotransferases, etc. A lot of people are worried when they find out that they have hepatitis B two pairs of half “major triplets” or “minor triplets”, so should they be treated at this time? Professor Wei Lai: This is a basic question, in fact, “major triplet” and “minor triplet” treatment or not, not according to “major triplet” and “minor triplet” to treat. The decision is not based on the “big three yang” and “small three yang”, at this time may be treated or not. If the transaminases of a friend with “major triple-positive” or “minor triple-positive” are both elevated, it may be appropriate to treat both. What is the key to this problem? It is whether the virus is present or not, and whether the virus is causing inflammation of the liver, which is manifested by increased transaminases, or whether the virus is causing cirrhosis, when transaminases are not high. In addition, the medical term “major triplet” and “minor triplet” is no longer used, but is a common term. In medical terminology, we call it e antigen positive slow hepatitis B and e antigen negative slow hepatitis B. If a friend is “major triple positive”, positive for the virus, and has elevated transaminases, we call this e antigen positive chronic hepatitis B. If a friend is e antigen negative, e antibody positive, HBV-DNA positive, and has elevated transaminases, we call this e antigen negative chronic hepatitis B. Of course, this is not enough, because “small triplets” may also be HBV-DNA positive or HBV-DNA negative. In the treatment process, sometimes we want to turn a “major triplet” into a “minor triplet”. For example, if a friend is e antigen positive, HBV-DNA positive and has elevated transaminases, i.e., e antigen positive chronic hepatitis B, what about the treatment process? Observe whether the e antigen will disappear after treatment, while the e antibody appears, the virus turns negative, and the transaminases are normal. When these conditions are met, we say that the treatment has been effective, but at this point the medication cannot be stopped, as we will discuss in more detail below. Therefore, whether or not to treat “major triplets” or “minor triplets”, the decision should be based on whether or not the transaminases and virus are positive. There are two types of carriage: HBV-DNA carriage and surface antigen carriage. Does it also mean that a “major triplet” or “minor triplet” may be chronic hepatitis B or a carrier? Prof. Wei Lai: Yes, such a person may be a patient or a carrier. That’s why I just mentioned that HBV-DNA is positive, surface antigen is positive, and transaminase is abnormal. If the aminotransferase is normal, you are not a patient, but a carrier. Of course, both “major triple-positive” and “minor triple-positive” may be carriers. However, regarding carriers, there are two cases: one is HBV-DNA carriers, who have the virus in their body, normal transaminases, and no cirrhosis on ultrasound; the other is surface antigen carriers, who are e antigen negative, HBV-DNA negative, and only surface antigen negative. The two types of carriage are different. HBV-DNA carriage has more chances of disease activity in the future, while surface antigen carriage has less chance of hepatitis activity in the future because HBV-DNA is negative. However, HBV-DNA negative in surface antigen carriers means that HBV-DNA cannot be detected in the blood, which does not mean that the liver is also negative for hepatitis B virus, at this time, HBV-DNA can often still be detected in the liver. Carriers, generally reviewed once a year You said that HBV-DNA carriers may still have the possibility of hepatitis activity in the future. So, is it necessary to review regularly to prevent hepatitis from occurring? Prof. Wei Lai: Yes, it is important to review regularly. If HBV-DNA is present in the body, that is, if the hepatitis B virus is present, the chance of cirrhosis and liver cancer increases compared to the average person; in addition, the presence of the virus in the body may cause inflammation of the liver. Therefore, the purpose of regular review is to detect, in time, whether HBV-DNA has caused liver damage, such as whether transaminases are elevated. If only the virus is positive, the transaminases are normal and the ultrasound is normal, this is the time to go without treatment. However, normal transaminases are not normal when the test is normal today, but in a continuous process. And this continuous process means that it is normal during the follow-up for six months to one year continuously. In addition, even though HBV-DNA does not cause obvious liver inflammation, some people will still develop cirrhosis and liver cancer over time, so regular follow-up can also detect cirrhosis and liver cancer early so that timely treatment can be given. So, how long should it be regular? For general people, it is necessary to test once a year to detect HBV-DNA fluctuation, transaminases, as well as ultrasound and blood routine. Among them, the changes of platelets in blood routine often also help us to indicate whether there is a progression of liver disease.