A patient with chronic hepatitis B has experienced elevated transaminases after interferon therapy, and is unsure whether it is right or wrong to take interferon, or whether it is possible to use enzyme-lowering drugs. We all know that antiviral therapy is closely related to serum transaminase levels, and that antiviral therapy works well when transaminase is elevated, but is it a problem if transaminase is still high after treatment? First, let’s review why aminotransferases are elevated in the case of hepatitis. Elevated transaminases are a sign that the body’s immune response is enhanced and that hepatitis is developing. After HBV infection, the body’s immunity will actively remove the hepatitis B virus from the liver cells under certain conditions, but this also causes damage to the liver cells, resulting in liver inflammation and the release of transaminases from the liver cells into the blood, hence the elevated transaminase levels in the blood test. Once HBV infection is found to have elevated transaminase levels, and after other causes are ruled out, antiviral therapy should be started, mainly because most patients with chronic hepatitis B have poor immune function, and although they attack the virus, the clearance ability is not ideal, and if they are not treated, it is often difficult to win with a single force, and the liver inflammation damage continues and the disease worsens. HBV DNA levels and ALT levels usually decrease after nucleoside analog therapy, but why is there an increase in transaminases after interferon therapy? Nucleosides and interferon are two completely different types of drugs with different mechanisms of action. Nucleosides mainly inhibit viral replication, and HBV DNA will drop soon after the drug is administered, and ALT will also follow, if HBV DNA rises after nucleoside therapy, it suggests that drug resistance has occurred. Interferon treatment for slow hepatitis B usually results in a decrease in serum transaminases to normal near the end of treatment. Because interferon has an immune stimulating effect, it is possible that transaminases may be higher during treatment instead. Clinical treatment and research reports have shown that if there is an increase in transaminases during interferon, there is more hope that the treatment will be effective, indicating that the body’s immunity has been stimulated as a result of the intense struggle with the virus. Interferon treatment usually takes 48 weeks, and if the transaminases remain high for such a long period of time, should the liver not be damaged? In fact, as long as the aminotransferase level is not very high, such as in the range of 100-200 U/L, it will not aggravate the disease. Take the clinical trial of PEG-IFN α-2a as an example: patients participating in the free clinical trial were required to have a liver puncture before and after 1 year of treatment. Most of the effective patients had higher transaminases during the treatment, but the liver tissue lesions were significantly reduced at the end of the treatment; few of the ineffective patients had aggravated liver tissue lesions, and most of them had also reduced, but not as much as the effective patients. This indicates that elevated transaminases do not aggravate liver tissue lesions during the 1 year of interferon treatment. Although elevated transaminases generally do not affect interferon therapy, it is important to be aware of the problem of sharply elevated transaminases. During interferon therapy, liver function should be checked once a month, and the number of tests may be increased if appropriate if transaminases are elevated. If a sharp rise in transaminases is found, a dose reduction should be considered and the drug should be discontinued if there is still a progressive rise or a rise in bilirubin. For whether to use this interferon again after recovering from a sharp rise in transaminases, or whether to take some oral enzyme-lowering drugs at the same time as using interferon, it is up to the specialist to decide on a case-by-case basis.