Hepatitis B is a progressive disease that can escalate to cirrhosis and liver cancer at any time as the hepatitis B virus continues to replicate at a high rate. In order to slow down the progression of the disease, patients should establish a holistic view of treatment and actively manage the disease effectively with anti-viral. Old knowledge: slow hepatitis B – cirrhosis – liver cancer, a path to black Once suffering from slow hepatitis B, patients will worry that they will “not return” to the “embrace” of liver cirrhosis and liver cancer. The reason is that 1 out of 4 patients with chronic hepatitis B will eventually die of cirrhosis or liver cancer; the chance of liver cancer is 100 times higher in hepatitis B patients than in the general population. The nightmare of the hepatitis trilogy “slow hepatitis B – cirrhosis – liver cancer” haunts the hearts of hepatitis B patients all the time. More than a decade ago, the proportion of hepatitis B patients developing cirrhosis and liver cancer was indeed very high. Because of the lack of effective drugs to control the replication of the hepatitis B virus at that time, doctors often lamented that they were “helpless”. Therefore, cirrhosis was first considered by the medical profession as an end stage of the development of slow hepatitis B, irreversible and unrecoverable. New knowledge: disease progression can be delayed, early cirrhosis can be reversed Many people believe that cirrhosis is an incurable disease, there is no room for maneuvering, in fact, this can not be generalized, at present we are not completely helpless against cirrhosis. There are now a large number of clinical studies that prove that high replication of the hepatitis B virus is the “culprit” for cirrhosis. Cirrhosis is no longer an “iron plate” that cannot be kicked, but as long as the replication of the hepatitis B virus can be effectively curbed, the progression of the disease can be slowed or even reversed. Three-year data from the landmark 4006 study in 2004 in the field of hepatitis B treatment confirmed that patients with early cirrhosis could reduce disease progression by 55% with 3 years of lamivudine treatment
and a 51% reduction in the incidence of hepatocellular carcinoma. This result is the first evidence that oral antivirals can slow disease progression and reduce the incidence of cirrhosis and hepatocellular carcinoma. In 2010, 10-year follow-up data from the 4006 study was released, finding that all patients had HBV DNA less than 300 copies/mL, 83% of patients experienced e antigen disappearance, 39% of patients had e antibodies, and patients had white blood cells.
Patients showed significant improvement in albumin, platelets and ALT (glutamate transaminase) from baseline. It is important to note that of the 16 patients who underwent two liver punctures before and after 10 years, 12 (75%) achieved histological improvement, 83.1% did not show disease progression, and some patients with early cirrhosis even showed a reversal from the Ishak fibrosis score of grade 5 at enrollment to grade 0 after 10 years, with grade 0 meaning the disappearance of fibrosis and a complete reversal of early cirrhosis. Cirrhosis caused by other etiologies also has a chance to improve, and the prognosis of cirrhosis is different depending on the etiology. In the case of cirrhosis caused by alcoholic liver and fatty liver, after strict abstinence from alcohol and weight loss, the cause of the disease will go away and the cirrhosis may stop progressing. Therefore, it is necessary to stop drinking, and if you do not stop drinking, it is impossible to reverse the development trend of cirrhosis. Early treatment: slowing down the progress The development of cirrhosis in chronic hepatitis B. The lightest, actually severe hepatitis with only a few small nodules forming, is called early cirrhosis. Early cirrhosis caused by hepatitis B is reversible after antiviral treatment, and a very large proportion can be removed from the cirrhosis. However, early cirrhosis is difficult to diagnose by ultrasound and CT, and can only be detected by liver aspiration. For mild to moderate cirrhosis after hepatitis B and C, although antiviral treatment cannot reverse the course of cirrhosis, it can delay its development very well, on the contrary, if the replication of hepatitis virus is not controlled, the course of cirrhosis will be faster. In short, the earlier the intervention of the cause, the greater the chance of reversing early cirrhosis or delaying its progression. Late treatment: prevention and treatment of complications If cirrhosis is only intervened and treated at an advanced stage, the overall effect is hardly satisfactory. The main goal is to prevent and treat complications, including control of portal hypertension, prevention of bleeding from ruptured fundic-esophageal veins, treatment of ascites, and hypoproteinemia. A series of serious complications will occur in the late stage of cirrhosis, and the treatment is rather passive. At this time, a large area of irreversible fibrosis has occurred in the liver, and it is difficult to treat cirrhosis from the etiological point of view. Liver transplantation is generally used for end-stage liver disease for which conventional medical and surgical treatment is ineffective. These include: irreversible ascites; portal hypertension with upper gastrointestinal bleeding; severe hepatic impairment (Child
grade C); hepatorenal syndrome; hepatic encephalopathy with progressive exacerbation; and cirrhosis complicated by hepatocellular carcinoma. Liver transplantation is the last resort in the treatment of end-stage cirrhosis, but liver sources are often scarce and costly. Therefore, it is crucial to control the disease in its early stages and should not be delayed until it needs to be decompensated, when it is too late. In conclusion: In addition to the causes of liver damage, cirrhosis has a chance to be controlled in the early stage, alcoholic cirrhosis patients must stop drinking, viral hepatitis caused by cirrhosis should be treated regularly, regular follow-up, antiviral treatment can control the progression of cirrhosis, the important thing is that the disease is not so bad before it is too late.