“Choose carefully and persevere” is the advice I have been given to every hepatitis B patient in recent years, before receiving antiviral therapy. If you too are facing confusion about antiviral therapy, you may wish to refer to the following advice. The increased understanding of antiviral therapy has been the greatest advance in the treatment of hepatitis B in the last 10 years, and the 2005 edition of the Guidelines for the Treatment of Chronic Hepatitis B has brought antiviral therapy to an unprecedented level. If you are treated in a regular hepatology unit, I am sure your supervising physician will mention this type of treatment if you are a patient with active hepatitis B virus replication and abnormal or once abnormal liver function. Why is antiviral therapy so highly recommended? Because a large body of clinical trial evidence shows that if a better response is obtained with antiviral therapy, the patient will have long-term stabilization of liver function and even improvement in liver pathology. Simply put, although the virus is not completely cleared, the patient’s liver disease will be well controlled and the rate of liver cirrhosis is substantially slowed; and the frequency of complications will be reduced in patients who have developed cirrhosis; even for the incidence of liver cancer. The above is a brief summary of the benefits of antiviral therapy. However, it cannot be denied that antiviral therapy is still very imperfect and currently faces multiple problems. In terms of efficacy, most drugs are not ideal. For patients with “major triple-positive” disease, interferon treatment for 1 year can only result in a full response in about 30% of patients. The average full response rate of several nucleoside antiviral drugs for 2 years is even less than 20%. And obtaining complete clearance of the virus is almost negligible. Therefore, before treatment, one should not be blindly optimistic, but should hold a cautiously optimistic attitude. With regard to the course of treatment, all drugs have a long duration. Those with a fixed course are the interferon antivirals, which are usually given for 1 year, and the course will be adjusted by the competent physician on a case-by-case basis, and will be discontinued regardless of the final response. Nucleoside analogs, on the other hand, are among the drugs that have a discontinuation indicator but no specific course of treatment. However, in the author’s experience, discontinuation is almost never possible in any chronic patient with a juvenile infection. Of course, it is possible that the case samples I have seen are biased and that many patients who discontinue medication may be out of the hospital monitoring system. However, you must be prepared to take medication for life before antiviral therapy, especially if you receive nucleoside antivirals. In terms of cost, all medications are expensive. Current medications cost about$15,000 for 1 year of regular interferon therapy, long-acting interferon is around$65,000, and the first year of testing and other treatments may cost about$5,000 for a more fixed course of treatment. There are more types of nucleosides, with the most commonly used entecavir costing about$15,000 for 1 year, adefovir about$0.5 million, and checkups and liver-protective medications costing about$5,000, but the course of treatment is potentially lifelong. In terms of adverse reactions, interferon has more adverse reactions, such as fever, decreased blood cells, decreased signs, hair loss, depression and other conditions, but most people are able to tolerate them under the guidance and adjustment of their doctors. Nucleoside adverse reactions are rare and are barely felt after use. Neither is recommended for offspring during use. Problems of drug resistance and mutation: There is a risk of decreased antiviral efficacy with either interferon or nucleoside antivirals. Among the nucleoside analogs, drug resistance mutations are more prominent. Such problems can be partially avoided through early monitoring and the choice of antiviral regimen. The above is a very concise analysis of the characteristics of antiviral drugs. Some patients, who already have some knowledge about hepatitis B and have done a lot of learning about antiviral therapy, may be able to determine an antiviral regimen quickly with appropriate counseling. However, many patients lack the knowledge background and still find it difficult to choose. So how do you quickly choose the right treatment regimen for you? My advice is to have a moderate consultation and recognize the risks you must take. Then choose a physician you trust and proceed with antiviral therapy under his or her guidance and monitoring. Just like financial investments, many people do not have investment experience, so we would choose an investment manager who would manage the investment of our money instead. In the moment of cheering for investment returns, we must realize that we must also take the risk of investment failure. It is the same in treatment. When we come to the hospital, all we need is the professional advice of the doctor. A doctor giving you professional advice will help you avoid the risks of treatment to the greatest extent possible within a predictable range. But in accepting this advice to maximize the benefits of treatment, you must also assume the potential risks of treatment. You cannot have a 100% chance of success with an unconquered worldwide disease like hepatitis B. Of course, it is also important to fully inform your supervising physician of your financial situation, special requirements (e.g., not yet married), nature of your work, and other factors that may affect treatment decisions before making them. Finally, it’s a matter of perseverance. Adequate implementation of a good program with good efficacy is a prerequisite for everything. Moreover, we have made it clear in HIV antiretroviral therapy that failure to use antiretroviral drugs regularly will lead to a significant increase in the rate of drug-resistant mutations. Therefore, regular use of medications is a must. Of course, being consistent does not mean you can take a year’s worth of drugs at a time and eat them from the beginning of the year to the end of the year. What you need is regular medication under the guidance of your physician, after all, there may be a variety of special circumstances during the treatment process and you are not in control of these. These are my antiviral opinions, and I hope they will help you in your treatment.