One of the misconceptions: ignore the disease and think you are right
Some patients have a clear diagnosis of chronic hepatitis B. However, they do not care about their condition and live their lives as they wish, drinking alcohol as usual.
Misconception No. 2: Just lower the enzyme, not antiviral.
For patients with chronic hepatitis B, the most fundamental cause of the disease is the infection of hepatitis B virus. Therefore, the most fundamental treatment for chronic hepatitis B is antiviral therapy. However, neither interferon alpha, pegylated interferon, nor the nucleoside analogs lamivudine, adefovir, entecavir, or telbivudine are effective in all patients.
Some patients lose confidence in the effectiveness of antiviral therapy and do not take antiviral therapy, but only care about liver-protective and enzyme-lowering therapy. Hepatoprotective and enzyme-lowering therapy only may provide temporary remission for a certain period of time in some patients, but rarely results in a final cure for hepatitis. Therefore, if antiviral therapy is appropriate, do not subjectively exclude antiviral treatment options, otherwise you will lose the time to treat.
Myth No. 3: Believe in advertising instead of hospitals.
Because of the limited efficacy of current formal treatment in the treatment of chronic hepatitis B, and because of the different views of experts in various regions on the current treatment of hepatitis B, and even the misconceptions of some hospitals or individual physicians, and the biased orientation of the news media to doctors’ opinions, patients have a crisis of trust in doctors, so it causes some patients’ trust in hospitals and physicians to decline significantly, and therefore turn to other As a result, some patients’ trust in hospitals and physicians has significantly decreased and they have turned to other informal medical channels. In addition to patients’ eagerness to seek medical treatment, the current management of medical advertisements is chaotic, and some advertisements exaggerate their claims, leading some patients to be deceived.
Myth No. 4: Excess worry and drug rejection.
Every drug has more or less some adverse reactions. However, the feelings and reactions to the same adverse drug reactions vary quite a bit from patient to patient. There are patients, who read in magazines and web pages that patients treated with nucleoside (acid) analogs, partly due to the mutation of viral genes, develop drug resistance and therefore reject nucleoside (acid) analogs. No matter how it is explained, it does not help. Some material has also been produced to demonstrate that inappropriate application can cause death in patients. For nucleoside (acid) analogue resistance, the reasons for changes in the condition of patients during the application of nucleoside (acid) analogues, and even the reasons for death cases should be analyzed on a problem-specific basis.
Myth No. 5: Ao anti-carrier, over-treatment.
Our chronic hepatitis B virus infection includes a significant proportion of people who test positive for viral markers but whose serum transaminase levels are always normal. In this part of the population, some patients do not understand the situation and blindly ask for “conversion”, thus spending a lot of money, but as a result, they spend money, suffer, but do not receive the desired effect. Strictly speaking, these patients should receive treatment because after all, there is virus in their bodies, and quite a few of them have liver biopsies that show varying degrees of liver inflammation, and the possibility of normal transaminases developing towards cirrhosis and hepatocellular carcinoma cannot be completely ruled out.
Therefore, strictly speaking, this group of patients with hepatitis B virus infection needs treatment. It is not correct to think that this group of patients does not need treatment. The problem is that this group of patients responds very poorly to the currently recognized effective antiviral treatment regimens both at home and abroad, so as a last resort, patients are advised to observe, have regular checkups, and refrain from special antiviral treatment for the time being.
Myth No. 6: Fear of mutation deters treatment.
The antiviral treatment for chronic hepatitis B, the drugs available are interferon alpha and nucleoside (acid) analogues. In the case of nucleoside (acid) analogs, some clinicians and patients have misconceptions about the cause of drug resistance, believing that it is the genetic mutation of the hepatitis B virus caused by the application of nucleoside (acid) analogs that leads to drug resistance.
Whether it is the genetic mutation of the virus caused by the application of nucleoside (acid) analogues or the process and result of drug selection is not difficult to resolve from a quasi-species point of view. From the results of foreign and our research, drug resistance in the process of applying nucleoside (acid) analogs is not a result of nucleoside (acid) analog drug induction, but an outcome of drug selection. From a quasispecies viewpoint, the hepatitis B viruses in the blood of hepatitis patients have small differences in their genetic sequences and are highly related; therefore, the hepatitis B viruses in the blood of each patient are a viral group consisting of genetically highly related viruses with small differences, and the components of this viral group are in constant change.
Therefore, the introduction and application of the quasispecies concept has changed our view of the state of existence of hepatitis viruses from that of a single virus to that of a population of viruses, and from a static state to a state of continuous change, thus revolutionizing our understanding of the state of existence of hepatitis viruses. From the quasispecies point of view, the viruses in each patient’s serum are diverse, and if one drug is applied, it is unlikely that it will have the same effect on all viruses, regardless of the mechanism of action and effectiveness of the drug. Then viruses that are sensitive to the drug are significantly inhibited, but those that are not sensitive to the drug are not significantly affected.
Therefore, after a period of time, the proportion of drug-sensitive viruses in the virus group will gradually decrease, and conversely, the proportion of insensitive viruses in the virus group will gradually increase. This dynamic process can only be understood if the state of existence of hepatitis B virus is viewed from a quasi-species perspective. Therefore, the correct view should be that viral genetic mutations originally exist, because the replication capacity of viruses with mutations is lower than that of viruses without mutations, so that mutated viruses occupy a minority position in the entire virus population, and after drug administration, the relative proportion of mutated viruses changes significantly due to the different sensitivity of different viruses to drugs, causing them to become the dominant population.
This makes it easy to detect. If the quasispecies theory does not strongly support this idea, the fact that mutant viruses can be detected in the blood of patients who have never applied nucleoside (acid) analogs, and even in the blood of hepatitis patients before nucleoside (acid) analogs were used clinically, fully supports our current understanding of the principles and processes of viral genetic variation and drug resistance development.
The clinician’s insight into the development of viral genetic variation and drug resistance can help to relieve patients’ concerns. Some patients are so worried about the emergence of mutation and resistance that they reject the application of nucleoside (acid) analogs, the main anti-hepatitis virus drugs, thus depriving some patients suitable for antiviral therapy of a good opportunity for treatment, which is unwarranted.
Myth No. 7: Psychological burden, not to end the day.
Chronic hepatitis B patients will eventually part of the patients will develop into cirrhosis, hepatocellular carcinoma and other end-stage liver disease, and lead to the death of some patients. A large number of clinical and epidemiological findings show that hepatitis B virus infection is a relevant factor for hepatocellular carcinoma. However, chronic hepatitis patients develop hepatocellular carcinoma in only a minority of patients, not all. This makes it a matter of odds for the individual. The progression from chronic viral hepatitis to hepatocellular carcinoma is the end result of multiple factors and long-term interactions, and the influencing factors are very complex. It is important to have a proper understanding of the possibility of developing hepatocellular carcinoma, both in terms of the correlation between hepatitis B and hepatocellular carcinoma, but also in terms of the fact that such a rate is not very high. Some of the measures we take to treat chronic hepatitis B are also important measures to prevent cirrhosis and hepatocellular carcinoma.
Myth No. 8: Care about technology and neglect treatment.
Advances in science and technology are the only correct way to finally address the treatment of chronic hepatitis B. Science and technology continue to advance and provide new therapeutic drugs and treatment techniques, and the desire of hepatitis patients for new technologies and treatments is completely understandable. Only the joint efforts of patients and scientific workers can finally solve this problem. Concern for new advances is not a substitute for current formal treatment.
I have encountered many patients who spend their days obsessed with finding new drugs and new treatments, but relatively ignore the current treatments that have been clinically proven to be effective. Individual patients are well informed about new advances, but suffer as a result and do not enjoy even the most basic therapeutic measures. For example, they are particularly concerned about upcoming therapeutic drugs such as Adefovir, Bacitracin, gene vaccines, and gene therapy, but do not use any of the drugs that are already in clinical use and proven to be effective, waiting only for new therapeutic drugs and new treatment technologies, thus delaying their disease.
Myth No. 9: Biased listening and lack of nutrition.
Chronic hepatitis B patients are not to avoid the mouth, how exactly to avoid the mouth, this is also chronic hepatitis B patients face an important problem. Because of the vast size of our country, the habits of different regions are different, therefore, the taboo situation of patients with chronic hepatitis B is not the same. However, we sometimes see malnutrition due to inappropriate avoidance of food, which has a significant impact on the immune system of the body, resulting in low resistance of the patient, which is not conducive to recovery from hepatitis.
Myth No. 10: Blindly turn negative regardless of the disease.
Although the hepatitis B vaccine has been applied for more than ten years, and the immunoprophylaxis of hepatitis B vaccine has achieved good results, we still see some young patients around 10 years old due to the unbalanced development of economic conditions in different regions and the different knowledge and attention to disease prevention. Once again, we call for the strengthening of scientific and popular knowledge of hepatitis B prevention and treatment, and the universal vaccination against hepatitis B. Because once you have hepatitis B, the treatment is very tricky, but the current hepatitis B vaccine has a very positive effect on immunoprophylaxis. Therefore, we should start with immunoprophylaxis to radically control the prevalence of hepatitis B virus infection nationwide.
Parents of children who have acquired hepatitis B virus infection without effective prevention are very anxious as the only child in the family. Since this group of children will encounter various difficulties in the future, such as enrolling in daycare and going to school, parents will do whatever it takes to treat them. This feeling is completely understandable, but it is important to deal with this situation calmly and scientifically, and not to treat blindly or excessively. Blind and excessive treatment will not only fail to help the affected child, but will probably have harmful results, which will be regretted in the end.