Currently, most chronic hepatitis B virus-infected patients in China are still satisfied with liver protection and enzyme-lowering therapy, and some people with higher level of knowledge have realized that viral diseases should mainly be treated with antiviral therapy, which is a leap of cognition. However, the existing anti-hepatitis B viral drugs are not likely to achieve a cure for most chronic hepatitis B viral infections. So, what is the point of antiviral therapy? What are the anti-hepatitis B virus drugs? The only anti-hepatitis B virus drugs approved are 2 types of interferon (common interferon and pegylated interferon) and 4 nucleoside analogues. There are a variety of domestic drugs for regular interferon; pegylated interferon is a long-acting preparation with 2 commercial products: Pyroxin and Pellegrin. The nucleoside analogs are lamivudine (Herceptin), adefovir (Haverix), entecavir (Boludin) and telbivudine (Sulbivir). China’s pharmaceutical market is in the process of consolidation, some drugs are advertised before they are approved; some drugs have been approved as liver protection drugs, but not as antiviral drugs. Regulated hospitals and regulated doctors can only use regulated drugs. What is the difference between interferon and antiviral oral medication? Interferon injections and antiviral oral drugs are two completely different types of anti-hepatitis B virus drugs: antiviral oral drugs have a direct anti-hepatitis B virus effect; interferon also has an antiviral effect, but is mainly an immunomodulator. The nature is different, the mechanism of efficacy is different, and the response is different. What are the characteristics of antiviral oral medications? Antiviral oral drugs are highly active, inhibit viral replication very quickly, and are effective in the vast majority of patients. After treatment, most patients with chronic hepatitis B can normalize their serum transaminases in just over 3 months; for patients with high viral levels, it takes more than 1 year, and for those with lower levels, the virus is not detected in just a few months; however, the effect on “major triplets” is very slow, and only 12-22% turn into “minor triplets” every year. However, the effect on “major triple-positive” is very slow, and only 12-22% of the patients turn to “minor triple-positive” each year. Anti-viral oral drugs need to be taken for a long time, there is no definite course of treatment, maintenance treatment to have a maintenance effect. Even if the serum aminotransferase has been normalized and the virus is not detected, after stopping the medication, most patients will relapse after a variable length of time. Seriously, 10-30% of them will have acute exacerbation, especially in patients with heavy and cirrhotic liver, which may have catastrophic consequences. After a long period of treatment with oral antiviral drugs, resistance to each drug may occur, and Herceptin is the one that occurs faster and more often. Thus, although antiviral oral medications are easy to take and rarely have adverse effects, they must be administered under the guidance of a physician. What are the characteristics of interferon? Interferon can be used for 6-12 months, and the indicator of efficacy is the clearing of “major triplets”, i.e. the e antigen (HbeAg) turns negative; the serum transaminase is normal; and the virus is not detected. Interferon is effective by stimulating the patient’s immunity, and the results are quite stable after stopping the drug, and even the “minor triplets” can be cleared after several years. Because interferon works by immune stimulation, the response of each individual is very different. Some patients get 3 efficacy indicators in 2-4 months, some in 2-3 years, and most patients take 8-10 months. Some patients remain ineffective even after a longer period of treatment. Treatment with interferon has a number of adverse effects, as it has been used for many years, the treatment is safe as long as it is done in close cooperation with the doctor and under his close observation. Some patients are not suitable for interferon, such as psychosis, uncontrolled epilepsy, autoimmune diseases, uncontrolled diabetes, uncontrolled moderate or severe hypertension, cardiac insufficiency, alcohol and drug abuse, jaundice, decompensated liver disease, etc. What is the immediate goal of antiviral therapy? For chronic hepatitis B with “major triplet” treated with interferon, the recent efficacy should be achieved: conversion of “major triplet” to “minor triplet”, undetectable HBV DNA and normal liver function. For chronic hepatitis B with “minor triple-positive”, HBV, DNA is not detectable and liver function is normal. Generally, patients with “major triple-positive” need to be treated for 8-10 months; patients with “minor triple-positive” are more prone to relapse and need to be treated for at least 12 months. Anti-viral oral medication can achieve normal liver function and non-detectable HBV DNA sooner, and it is necessary to change medication in time before drug resistance occurs during long-term treatment. What is the ultimate goal of antiviral therapy? The hepatitis B virus in the liver cells, where the DNA of HBV is preserved in the nucleus from drug and immune action; and the viral molecules integrated with the patient’s chromosomes. The available anti-hepatitis B virus drugs are not yet likely to achieve a cure for most chronic hepatitis B virus infections. Antiviral therapy clears the virus and cures few, but in most patients it can inhibit viral replication, relieve inflammation, and prevent progression to cirrhosis, liver failure, and hepatocellular carcinoma. The main goal of antiviral therapy should be to prevent cirrhosis, liver failure and liver cancer. Without aggressive treatment, chronic hepatitis B is a disease with a poor prognosis, and once it progresses to ascites, hematemesis or liver cancer, it becomes more difficult to treat. What are the advantages and disadvantages of each of the two types of antiviral drugs? Antiviral oral medications have a direct anti-hepatitis B virus effect, inhibit viral replication more strongly, relieve symptoms more quickly, and provide therapeutic benefits for a very large majority of patients. Interferon also has an antiviral effect, but it is mainly an immunomodulator. Each patient has a different response to stimulate immunity, and not every patient is effective. Chronic hepatitis B is not a disease that can be treated in the short term. After the “major triplets” are cleared, the “minor triplets” remain for a longer period of time and cannot be considered cured. The antiviral oral medication has no immune effect, so it can be discontinued within a few years, and after discontinuation, most of them will relapse; patients who are successfully treated with interferon have stimulated sufficient immune function, and the clearance rate of “major triplets” is higher, so after discontinuation of the medication after conversion to “minor triplets”, it can The antiviral effect is relatively stable, and some of the patients with effective treatment can be cured within a few years after the clearance of “small triplets”. What are the advantages of long-acting interferon? Long-acting pegylated formulations are the second generation of improved interferon and have the same common characteristics of interferon. While regular interferon is injected three times a week and only maintains a therapeutic concentration for about 10 hours each time, long-acting interferon is injected once a week and maintains a constant concentration of the drug in the blood. Long-acting interferon significantly improves the efficiency of treatment; it may also be effective in refractory patients with very high viral levels; some patients who have failed treatment with regular interferon have gained efficacy after switching to long-acting interferon. The recurrence rate of the disease is very low when treated with long-acting interferon, which is a good choice for patients who are prone to relapse. Long-acting interferon increases the efficacy of the treatment by extending the blood concentration, but also increases the adverse effects, which are of the same nature as those of regular interferon. Can long-acting interferon cure chronic hepatitis B? After a 1-year course of long-acting interferon, more than half of the patients can obtain stable therapeutic effects, i.e., “major triplet” to “minor triplet”; normal serum transaminases; and no detectable virus. Nearly 10% of these effective patients had cleared even the hepatitis B surface antigen (HbsAg), which represents the “minor triplet”, at the end of treatment, which is higher than the clearance rate of regular interferon. With the clearance of “minor triplet”, chronic hepatitis B can be said to be cured. Although patients with “minor triplets” have controlled significant viral replication, the hepatitis B virus still exists in the liver cells, and patients with effective interferon therapy already have strong immune function and can continue to inhibit viral replication. In this way, the new liver cells will not be infected, the virus infected liver cells will be aging and metabolized, after a varying length of time part of the patients are able to clear the “small triplet”. The common interferon has been treating chronic hepatitis B for 20 years, and nearly half of the patients cleared their “minor triplets” after 5 years of long-term observation; the long-acting interferon (Pyroxin) is stronger than the common interferon, so the long-term effect is certainly better. Therefore, we cannot consider the cure of chronic hepatitis B as the immediate goal, but it can be a reliable hope.