Facing hepatitis B, we used to be very helpless, and we were also annihilated by small and fake advertisements, and ran into walls everywhere. Today, after oral antiviral drugs have been marketed for more than 10 years, with the accumulation of experience of classical oral antiviral drugs in clinical practice, and with the continuous listing of new oral antiviral drugs, clinicians have been exploring and exploring the means and techniques for the treatment of hepatitis B. Their confidence in the treatment of hepatitis B is also increasing. The Department of Infectious Diseases, Southern Hospital of Southern Medical University, Peng face hepatitis B, as long as there is a correct perception, correct attitude, and actively cooperate with the doctor’s treatment, life is as wonderful! In the face of hepatitis B, there is a saying shared with hepatitis B friends: stand up straight and resolutely do not get down!
Hepatitis B treatment is a marathon.
Long-term antiviral, forceful resistance to the “hepatitis B trilogy:”
Hepatitis B treatment is a marathon, although there is no treatment method that can completely eradicate the hepatitis B virus, but as long as hepatitis B patients in this race can adhere to the “endurance, skills, and peace of mind” the “nine words of the secret”, long-term effective antiviral However, as long as hepatitis B patients can adhere to the “nine keys” of “stamina, skill and peace of mind” in this game, and engage in long-term effective antiviral treatment, they can delay the progression of hepatitis B to cirrhosis and reduce the occurrence of liver cancer.
A landmark prospective study, the 4060 study, demonstrated that after 3 years of treatment with the oral antiviral drug lamivudine, the progression of liver cancer and liver fibrosis could be reduced by 50%. This means that having hepatitis B is not necessarily a trilogy of “hepatitis B – cirrhosis – liver cancer”, as long as the treatment is timely and appropriate, hepatitis B can be well controlled and can be treated. As long as the treatment is timely and appropriate, hepatitis B can be well controlled and the progress can be delayed to the greatest extent to reduce the occurrence of liver cirrhosis and liver cancer.
The antiviral treatment of hepatitis B is a long-term process, hepatitis B friends should have a positive mindset, in the belief that antiviral treatment is a powerful weapon against hepatitis B, while enriching their knowledge of hepatitis B treatment, to treat treatment with a scientific attitude, do not “hearsay”, “partial hearing is believing “The first step for newcomers is to take the first step in the process.
The first step for newcomers: the analysis of common keywords for hepatitis B patients.
The first step is to understand the basic concepts of hepatitis B and treatment, and to grasp these basic concepts, so that hepatitis B friends can better understand the doctor’s treatment plan and actively cooperate with the doctor’s treatment. The first thing you need to do is to understand the basic concepts of hepatitis B and treatment. As the saying goes, “The more we know about hepatitis B, the stronger we will become and the more initiative we will have in the fight.
Keyword one: Hepatitis B virus HBV DNA.
Hepatitis B virus DNA represents the activity of hepatitis B virus, the higher the HBV DNA, the more active the virus replication. If the detected HBV DNA is ≥ 1×105 copies/mL, it means that the hepatitis B virus is more active in replication and the amount of virus in the body is high. However, the hepatitis B virus does not directly damage liver cells, and the amount of virus replication does not indicate the severity of liver cell damage. Many infected people with active hepatitis B virus replication have normal liver function. Therefore, the amount of viral replication should not be taken as a marker of liver damage; liver function is the clinical indicator of the degree of liver damage.
Keyword 2: major triplet and minor triplet.
The five hepatitis B tests are a marker for diagnosing whether or not you are infected with hepatitis B virus. The so-called “hepatitis B five” is a ranking of five tests, which are hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B e antigen, hepatitis B e antibody, and hepatitis B core antibody in that order. Usually, 1, 3 and 5 positive (or +) are also called major triplets, and 1, 4 and 5 positive (or +) are called minor triplets.
Patients with “major triplet” and “minor triplet” are both infected with the hepatitis B virus, but not all of them are hepatitis B patients, and are diagnosed with hepatitis B only if they have abnormal liver function. A person with hepatitis B virus infection with normal liver function is called a “carrier” and does not need hepatitis B treatment for the time being, but needs to be monitored and followed up regularly.
Keyword 3: Liver function and ALT.
Liver function is a reflection of the physiological function of the liver, and liver function tests are designed to detect the presence of liver disease and the degree of liver damage. Liver function tests are particularly sensitive and important for the determination of hepatitis, cirrhosis and other diseases.
The exact liver function index should include liver physiological capacity, synthetic function, metabolic function, detoxification function and so on. However, our current clinical so-called liver function is still very incomplete, only the serum protein level of which can indirectly reflect the synthetic function of the liver. The most commonly used clinical level of glutamic aminotransferase (ALT) only responds to the degree of inflammatory activity of hepatocytes and cannot really reflect liver function, but for a long time people are used to mistakenly call it a liver function indicator. When the ALT indicator is persistently or intermittently abnormal and accompanied by active hepatitis B virus replication, it indicates inflammatory activity of the liver cells, and the patient needs to have an “interview” with the doctor to consider antiviral therapy.
Keyword 4: drug resistance.
The hepatitis B virus knows the principle of “survival of the fittest” and mutates to avoid drug attacks, making it less sensitive to drugs, which is called hepatitis B virus drug resistance. All oral antiviral drugs can be resistant, but resistance does not mean that treatment has failed, as long as the doctor adjusts the treatment plan and adds appropriate drugs, the effectiveness of the original oral antiviral drugs still exists.
Even if resistance occurs, it can be controlled by changing the treatment regimen as early as possible and the development of the disease. Drug resistance is preventable, treatable and manageable. Patients with hepatitis B should face drug resistance with a positive attitude, without excessive fear.
Keyword 5: follow-up and monitoring.
Follow-up and monitoring is an essential part of the hepatitis B treatment process. Hepatitis B treatment is like driving a long distance. Before you leave, you need to check the condition of your car, gasoline, and choose a good departure route. After you leave, you should pay attention to the traffic signs along the way, and at important intersections, you must look at the road signs clearly before you go forward, otherwise you will go in the wrong direction and not reach your destination. The same is true for hepatitis B treatment. Before treatment, you have to choose the drugs and guidelines, and during treatment, at some important points in time, such as 24 weeks of treatment, you have to monitor and follow up, and you may have to make an adjustment.
Regular monitoring and follow-up can determine the effectiveness of antiviral therapy in a timely and accurate manner so that physicians can adjust the treatment regimen in a timely manner and effectively prevent drug resistance. Especially at the inflection point of 24 weeks (six months) of antiviral treatment, patients with chronic hepatitis B should go to the hospital for routine tests such as HBV DNA, liver function and hepatitis B five to observe whether the original antiviral treatment regimen is working. If HBV DNA turns negative and liver function returns to normal, continue the original treatment; if hepatitis B virus replication is still “rampant” and liver function is abnormal, patients taking lamivudine need to consider adding adefovir (such as Haverix). Patients on other medications who do not have a negative HBV DNA at 24 weeks will also need to be treated with non-cross-resistant medications to achieve better outcomes. Effective monitoring and follow-up can effectively prevent and manage drug resistance, so patients with hepatitis B do not need to talk about “drug resistance” and sink into the shadow of fear.
In addition, long-term regular monitoring and follow-up can identify adverse drug reactions in a timely manner and can effectively “set things right”. For example, patients who are taking tibivudine need to have their CK levels checked regularly. If the CK rises to more than 5 times the upper limit of normal and is accompanied by myalgia, stop tibivudine immediately and switch to other safe and effective antiviral drugs.
Relax and face hepatitis B head on.
Hepatitis B treatment is a long and complicated process, and it is not possible to get rid of the disease overnight. In the process of hepatitis B treatment, the mindset of hepatitis B friends is a very important aspect. Some hepatitis B friends are either more anxious when they first discover hepatitis B, hoping for a complete cure; some are either more pessimistic, thinking that life has changed since then. In fact, the more you know about hepatitis B, the better your mindset will be instead. At present, although hepatitis B cannot be cured, antiviral treatment can already inhibit the virus very well and can achieve the ultimate reduction of cirrhosis and liver cancer. Therefore, it is recommended that hepatitis B friends should try to put their minds at ease in treatment and actively cooperate with doctors to achieve the best treatment effect.