Case Sharing: Female, 38 years old, had Hepatitis B “small triple Yang” since childhood, but was tested negative at 20 years old. Her father died of liver cancer, her mother’s mother’s family are all hepatitis B carriers, and her great-uncle is the only one who has hepatitis B. She was infected with hepatitis E in 2008. I was infected with Hepatitis E in 2008, my liver function was more than 2000copies/ml and bilirubin was more than 180µmol/L. I was hospitalized and discharged. Bilirubin was still high, after taking traditional Chinese medicine for half a year, ultrasound: splenomegaly was 4.2cm; enhanced CT in the provincial hospital: spleen was slightly larger, lower esophageal vein was slightly thicker, and there was no obvious abnormality in the liver. Virus negative, serving turtle shell soft liver tablets for 3 years, in which also took a lot of liver protection drugs, check ultrasound liver morphology did not see obvious abnormalities, liver envelope is still smooth, parenchymal echogenicity is not homogeneous, splenomegaly 4.5cm. HBV DNA: 2011 2.94E + 02copies/ml; 2012 6.38E + 02 copies/ml; 2014 1.83E + 02 IU/ml. In 2014, the hardness value of liver fiber scan is 4.3KPA, liver function and blood routine are normal, may I ask Mr. Luo if I have cirrhosis? Is the antiviral treatment, how to treat? “Minor triple yang”, liver function is normal, every time the test virus low level positive, if only so, not enough to diagnose hepatitis. However, at the age of 38, with splenomegaly and mild portal hypertension, and with my father’s liver cancer, antiviral treatment is necessary for a comprehensive judgment! Choose Paroxetine, can prevent cancer, but the recurrence rate is very high, the cost is very high; choose Tenofovir, 5 years of lesion reversal about 70%, more expensive, with entecavir can also be, lesion reversal is slower. [Disease Analysis] Do people with low levels of virus and normal transaminases not need antiviral therapy? For the most part, yes, but there are exceptions, and it may be that these exceptions are more likely to need antiviral therapy. So, what kind of people are he/she? “Minor”, imported reagents check virus 5 times copies/ml (domestic reagents check 4 times, but sometimes inaccurate) is a red line, in the following weighting factors at least 1 can be diagnosed “minor” hepatitis: 40 years old. Platelets <100X109/L on several tests, slightly enlarged spleen, liver cancer in a close relative, and possibly others. To diagnose "triple positive" hepatitis, one must have an ALT > 2 times the normal high value for 3 months. Why can ALT be normal in “small triple positive” hepatitis? In the early stage of “triple positive” infection, there is immune tolerance, and during the period of immune tolerance, the disease does not develop, or the disease is too mild for antiviral treatment to be effective. In “small triple positive” infection, the immune tolerance has long disappeared, and the infection is a mutated virus with low virulence, and the transaminase does not necessarily increase, so the level of viral replication is more important than the transaminase. However, “normal aminotransferase” lacks a quantifiable marker, so in order to avoid misdiagnosis, it is necessary to add a weighting factor. What is the relationship between age and antiviral therapy? The diagnosis of hepatitis “triple III” can be made in people over 40 years of age when the imported reagent for “triple triple III” tests the virus to the 5th power of copies/ml. Why? Almost all of our people’s hepatitis B virus is infected in infancy, 40-year-old people have been infected for more than 30 years, although it is a chronic carrier, but there is always some damage every year (so the medical term is called “chronic asymptomatic carry”, not called “chronic health carry”). Although it is very mild, over time, over decades, generally have a slight inflammation and fibrosis, so as a weighted factor of extra points. In the case of “triple positive” carriers, they are immune-tolerant until adolescence, with little or no liver damage. As they grow older, their immune tolerance gradually decreases, and if they are still “triple positive” at the age of 60, the virus will not be too low, and even if their ALT is normal, they are suitable for antiviral treatment. What is the relationship between a family member’s liver cancer and antiviral therapy? For “small triple positive”, imported reagents show that the virus is 5 times copies/ml, which is a red line. A close relative with liver cancer is also 1 weighting factor. What kind of cirrhotic patients need antiviral therapy? Cirrhosis patients who are positive for the virus are called “active cirrhosis”, meaning that the lesions are still active and may continue to worsen, and the liver cells of these patients are particularly vulnerable to viral defense. Regardless of the level of the virus, as long as the virus is positive, antiviral treatment is indicated. The efficacy of antifibrotic drugs is not yet certain, and the more the liver is used for 3 years of treatment, the harder it gets; only antiviral drugs are definitely effective against liver fibrosis, and long-term use of first-line nucleoside analogs (entecavir or tenofovir) may gradually soften the disease.