Since the discovery of AusAID in 1965, we have never stopped fighting against hepatitis B. We have experienced the helplessness of “combining many hepatoprotective drugs still cannot reduce the level of active chronic hepatitis B transaminase”, “lamivudine” when it was first launched and blindness. We have experienced the helplessness of “combining several liver-protecting drugs still fails to reduce the transaminase level of active chronic hepatitis B”, the joy and blind acceptance of “lamivudine” when it was first marketed; as well as the helplessness and fear after the emergence of viral resistance and rebound after stopping drugs, the “overkill” resistance to antiviral; and the “overkill” resistance to antiviral in large samples. “With the help of large samples and evidence-based medicine, we have also witnessed a large number of patients benefiting from sustained suppression of the hepatitis B virus, and proposed a series of therapeutic indications for antiviral treatment in patients with chronic hepatitis B. The 2005, 2010 and 2015 Chinese Guidelines for the Prevention and Control of Chronic Hepatitis B, as well as major international guidelines, all state the same goal for the treatment of patients with chronic hepatitis B: “Maximize long-term suppression of HBV replication, reduce hepatocellular inflammatory necrosis and hepatic fibrosis, and delay and minimize hepatic failure, cirrhosis, hepatocellular carcinoma and other complications, thereby improving quality of life and prolonging survival. , thereby improving quality of life and prolonging survival time.” For ordinary patients, it is not easy to realize that “antiviral treatment is necessary for chronic hepatitis B.” But in order to have antiviral treatment, it is also necessary to have antiviral treatment. However, if you want to take antiviral treatment, you need to know some basic knowledge about antiviral drugs. 2. Who needs antiviral treatment? Not all HBsAg positive patients need antiviral treatment. Chronic hepatitis B virus infection is clinically categorized into several types: ① only hepatitis B surface antigen (HBsAg) positive, but hepatitis B virus (HBVDNA) negative, normal liver function, known as inactive HBsAg carriers. ② Those who are positive for HBsAg and HBVDNA and have normal liver enzymology (ALT) are called chronic HBV carriers. ③ Those who are positive for HBsAg and HBVDNA, with normal liver enzymology (ALT), and whose HBeAg can be either positive (major triple positive) or negative (minor triple positive), are called e antigen positive and negative chronic hepatitis B. For the first two, the risk of developing cirrhosis and related complications is low, and they are not classified as candidates for antiviral treatment for the time being. (The reason why we say temporarily is due to the limit of treatment means, if in the future there is a drug that can easily eradicate chronic hepatitis B, then we will have to modify this indication. Patients belonging to classification ③ have a higher risk of disease progression and are our target population for antiviral therapy. And clinically, in order to clarify the maneuverability of this indication. And in order to clarify the operation of this indication, and further on the serum HBV DNA level, serum ALT and the severity of liver disease to make further provisions, to meet the following two conditions can be antiviral treatment: “(1) HBV DNA level: HBeAg-positive patients, HBV DNA ≥ 20,000 IU/mL (equivalent to 105 copies / ml); HBeAg-negative patients (1) HBV DNA level: HBeAg positive patients, HBV DNA ≥2000 IU/mL (equivalent to 104 copies/m l ); (2) ALT level: generally, ALT is required to be consistently elevated ≥2×ULN (more than 3 months); if interferon is used for treatment, ALT should be ≤10×ULN in general, and serum total bilirubin should be <2×ULN;" - -Chinese Guidelines for the Prevention and Control of Chronic Hepatitis B, 2015 3. What are the antiviral treatments for chronic hepatitis B? There are only two currently recognized anti-hepatitis B virus treatment options: interferon (regular interferon and long-acting interferon) therapy; or oral nucleoside analogs. Interferon is subdivided into long-acting interferon: the imported Paroxetine and Pelargonium, and the domestically produced Pegabine and Terbol interferon. There are many brands of generic interferon, such as Seroquel, Yundexin, Amphotericin, and Kayin Yisheng. Nucleoside analogs available domestically are lamivudine (Heptin), adefovir (Herve Leigh, Dyding, Mingzheng, etc.), tibivudine (Subivudine), entecavir (Boludine, Runzol, Tendin, etc.) and tenofovir. It should be emphasized that some hospitals use "nano", "ozone", "gene", "biological therapy", etc. as publicity gimmicks to deceive patients. It should be emphasized that some hospitals use "nano", "ozone", "gene", "biological therapy" and so on as publicity gimmicks to deceive patients into paying high treatment fees. (A patient was once treated in a military hospital with a kind of treatment called "ozone therapy" for the eradication of hepatitis B. The specific process was that the patient was first given oral treatment for hepatitis B. The patient was then given the treatment by mouth. The specific process is, first give the patient oral nucleoside drugs, and then collect the patient's blood about 200cc, the blood and "ozone" mixed contact half an hour, and then back to the patient. The charges were huge. The patient treatment for six months, spent 30,000 yuan, was told that "hepatitis B" has been cured, you can stop using the oral nucleoside drugs, the results of the withdrawal of the patient appeared after the rebound of the virus, hepatitis activities, jaundice, fortunately, came to our hospitalization, re-use standardized antiviral drugs can be controlled.) So the majority of patients must keep their eyes open and not be deceived. 4. What are the advantages and disadvantages of interferon injection and nucleoside oral drugs? Nucleoside drugs have stronger antiviral effects, can rapidly inhibit viral replication, and are effective for most patients. It is convenient to take only 1 tablet per day and there are few adverse effects. However, nucleoside analogs need to be taken for a long period of time to maintain the effect of the treatment and cannot be stopped at will. Even if the serum aminotransferase has been normalized and the virus has turned negative, there are still a considerable number of people who have relapsed after stopping the drug at this time, and drug resistance may also occur with long-term use. Therefore, the 2015 China Chronic Hepatitis B Prevention and Treatment Guidelines recommend that for patients who decide to receive antiviral treatment with nucleoside analogs, entecavir or tenofovir are preferred as potent, non-resistant drugs. Long-term treatment (at least 5 years) is required, and the longer the treatment, the greater the benefit. The advantage of interferon therapy is that there is a fixed course of treatment (usually 12 months), the efficacy is obtained by stimulating the patient's immune system, the efficacy is quite stable after stopping the drug, there is no problem of drug resistance and discontinuation, and the efficiency of clearing up the "big three suns" is higher. However, the use of interferon therapy has more adverse reactions than nucleoside oral drugs, generally used in compensated chronic hepatitis B, patients who can make the relevant examination according to the regulations, is also safe. 5.Which patients are more suitable for interferon antiviral therapy? It is generally believed that relatively young patients, patients who wish to have children in the near future, patients who expect to complete treatment in a short period of time, and patients who are receiving antiviral therapy for the first time should be prioritized and recommended to receive interferon therapy with a relatively shorter and more regular course of treatment. To take a step back, even if interferon therapy does not achieve a satisfactory therapeutic endpoint (i.e., clearance of "triple III", viral turnover, and normal liver function), it is possible to continue treatment with oral nucleoside analogs. Younger patients can use interferon first to try, if successful, can achieve satisfactory endpoints, and may even reach the ideal endpoint of treatment, "HBsAg turn negative, hepatitis B cure". "Always dream, what if it comes true?"