In clinic and online consultations, we often encounter many patients who give themselves the title of “hepatitis B carriers”. Since true carriers can remain untreated for a considerable period of time, a misdiagnosis often leads to disease progression and even irreversible consequences. Such lessons can be numerous in clinical work. The most common situation is that many non-professional doctors classify patients as carriers based only on one or two normal liver function test results, without other evidence to support them; there are also many patients who self-identify themselves as carriers based only on their superficial knowledge of hepatitis B. Once the concept of carrier is deeply rooted in the heart, patients often do not do regular follow-up examinations for several years or more, or even indulge in their own lives (drinking, overworking, uncontrolled diet, etc.), and only come to the clinic once their disease progresses to an advanced stage with obvious symptoms, but it is too late. As a simple example, many patients with compensated cirrhosis (some of them are very young) may have “completely normal” liver function test results at the first visit, and if they are diagnosed as carriers based on this result alone, many of them lose their vigilance and lose follow-up for many years, and wait until their disease progresses to advanced cirrhosis with complications Many people lose their vigilance and are not followed up for many years, and only come to the clinic when their disease progresses to advanced cirrhosis with complications (ascites, hepatic encephalopathy, upper gastrointestinal bleeding, liver cancer, etc.), thus causing irreparable damage to patients. So what are the conditions that a true carrier should meet? There is a clear definition in our latest national guidelines for the treatment of slow hepatitis B in 2010: 1. Chronic HBV carriers: mostly HBsAg, HBeAg and HBV DNA positive people in the immune tolerance period, with more than 3 consecutive follow-ups within 1 year showing serum ALT and AST in the normal range and no significant abnormalities in liver histology. 2. Inactive HBsAg carriers: serum HBsAg positive, HBeAg negative, anti-HBe positive or negative, HBV DNA below the minimum detection limit, more than 3 consecutive follow-ups within 1 year, ALT all within normal range. Hepatic histology showing Knodell’s Hepatitis Activity Index (HAI) < 4 or mild lesions as determined by other semi-quantitative scoring systems. In summary, the two carrier states have something in common: normal liver function and a histologic examination of the liver with little or no inflammation. There are also differences: the former are mostly young patients, with the majority infected at an early age and vertically infected from mother to child at birth, with a high HBV load; the latter tend to be older, mostly transformed from the former after an immune clearance period, or may evolve directly from a relatively strong immune response at the time of initial infection, with the five items of hepatitis B being "small three positives "Most of the carriers have a negative HBVDNA. It seems that the diagnosis of carriers is not a difficult task, but it is not. As most hepatologists know, it is often not enough to diagnose a carrier based on the results of three liver tests within a year. There are often many uncertain factors in the evolution of the history of hepatitis B, such as differences in the degree of exertion, mental status, dietary structure, whether or not alcohol and other liver-damaging drugs were consumed, whether or not other viral hepatitis was combined, and changes in the immune status of the body (including immunosuppressive drugs for other diseases) that may cause and induce episodes of liver inflammation and take the patient out of the "carrier" status. In addition, as the gold standard for carrier diagnosis, liver biopsy histology is not acceptable to every patient, nor is it available in every region or hospital, nor is it necessary for every patient from the perspective of economic cost. As a clinician, you should "recommend" but not "force". So, what should clinicians and the "general public" know about diagnosing carriers? First of all, as a doctor, you should do a comprehensive laboratory examination for the patient at the first visit, including: a detailed physical examination, as well as liver function, routine blood tests, quantification of the five hepatitis B items (virus quantification can be done after the diagnosis of hepatitis B), liver ultrasound and other laboratory tests, liver biopsy is important but not necessary. Liver biopsy is important but not necessary. Most carriers of the first type do not need to have a liver biopsy, while carriers of the second type can often be diagnosed only with a liver biopsy in some cases. For patients who do not have the conditions for liver biopsy or whose doctors' experience and knowledge suggest that liver biopsy is unnecessary, ultrasound is very important. The diagnosis of "no abnormalities in liver, gallbladder and spleen" made by an experienced ultrasound doctor is the best initial diagnosis for carriers. The best confirmation for carriers is that there is no significant change in ultrasound performance of the liver during long-term follow-up. If the patient's laboratory and test results meet the carrier criteria in the guidelines, what should be done after the patient is initially identified as a carrier? "As the saying goes, practice is the only test of truth, and practice is bred in time, and time is the best measure! After years of regular follow-ups and examinations, the patient's physical condition and the results of laboratory tests and examinations remain unchanged or basically unchanged, which is the best affirmation for carriers. In practice we have met many patients with carrier status who have not undergone treatment but whose physical and liver conditions have not changed significantly for decades is the best example. However, for most patients, carriage is not permanent but only a certain stage of the disease process. Under the influence of many factors, patients may leave carriage at any time and enter the inflammatory activity stage. "The reason why the word "see a doctor" is used is that a doctor cannot be with you at all times, and only you can keep track of your own physical condition. There is a word in English called "see a doctor", which is the best interpretation of this concept. In previous articles, we have mentioned the three endpoints of antiviral therapy for hepatitis B. This is both a harsh reality and a hopeful journey. Once again, let's summarize the treatment of chronic hepatitis B: clearing the virus is a dream (and dreams can occasionally become reality), being a lifelong carrier is an ideal, and adherence to treatment and a good life is not a fantasy.