Patient: I have heard from my patients that the viral variability that occurs with Lamy is very high. Is it, is not with other good, injection, can and I say the cost. In the field if so see the doctor will not be very troublesome, thank you Tianjin Infectious Diseases Hospital Infection Department Wang Zhenyu: antiviral can be roughly divided into two categories of drugs, one, interferon 1, ordinary interferon, 2,000 yuan per month, to 2-3 months onset of effect, the effective rate of 35-45%, the rate of obvious adverse reactions 30%, 30% of the mild adverse reaction 2, long-lasting interferon, 5,000 yuan per month, 2-3 months onset of effect, the effective rate of 40-55%, the mild adverse reaction 2, long-lasting interferon, 5,000 yuan per month, the 2, long-acting interferon, 5,000 yuan per month, 2-3 months to take effect, the effectiveness rate of 40-55%, the rate of obvious adverse reactions 30%, 30% of mild adverse reactions, the beginning of the treatment need to be hospitalized 2, nucleoside 1, Lamy, 400 yuan per month, 1 month to take effect, the effectiveness rate of 85%, no adverse reactions, one year resistance rate of 20%, experienced doctors (such as me), can be limited to 30% of the total rate of drug resistance. The use of Lamy makes the surface antigen negative cured people in my place can be used “row” to calculate. 2, Adderall, imported 550 yuan per month, domestic 300 yuan per month, 2 months effective, more than 90% effective rate, few adverse reactions, one year resistance rate of 10% or less. The success rate of stopping the drug is 0, 1 case of Ade surface antigen conversion after Lamy resistance, 1 case of Lamy + Ade surface antigen conversion. 3, Tibi, 650 yuan per month, effective in 1 month, the efficiency is slightly higher than that of Lamy, fewer adverse reactions, but some are very serious, can be fatal, the one-year resistance rate of 15%, the experienced doctors (such as me) basically do not use this drug. But I used this drug to make a 5-year-old child three years surface antigen negative. 4, Entei, 1200 yuan per month, 1 month onset of effect, more than 90% effective rate, no adverse reactions, one year resistance rate of 10% or less, compared with Lamy in the first six months of efficacy there is no difference. Lami ade multiple drug resistance after Entebbe treatment successfully discontinued 1 case (last year), surface antigen conversion 1 case (this year) 5, Tylenol, is not yet listed, but can get from the illegal way Patient: description of the disease (onset time, main symptoms, hospital, etc.): March 06 check found triple yang, when the liver function is normal, no treatment. 06 October check the liver function is normal HBV HBV-DNA2,68×10 to the 7th power, surface antigen HBsAg 》225,surface antibody HBsAb 3,48 reference value 0-10, e antigen positive, core antibody positive. In July 07, the glutamic acid aminotransferase 57, reference value 0-40, glutamic acid aminotransferase 40 reference value 0-40, HBV-DNA 1, 18 × 10 of the 7th, the doctor gave me 20 days of five ester tablets liver function is normal. On February 13, 2008, the alanine aminotransferase 127, glutamic oxal transaminase 93, began antiviral therapy, with 3 months of interferon. on May 27, 2008, HBV-DNA2, 94 × 10 of the 7th doctor said interferon is not effective to change to lamivudine (Herceptin) + adefovir (Mingzheng) to take 2 weeks after the HBV HBV-DNA2, 15 × 10 to the 4th power, 4 weeks later HBV-DNA1, 94 × 10 to the 3rd power due to economic considerations stopped Lamy single adefovir 6 weeks after the virus rebound HBV-DNA5, 41 × 10 to the 6th power, and then add Lamivudine April 2009 The DNA turned negative and he stopped taking the medicine and changed to Chinese medicine. On November 17, 2009, the liver function abnormality glutamine aminotransferase 314, glutamine aminotransferase 174, began to protect the liver to reduce the enzyme single dose of lamivudine, in March 2010, the DNA turned negative. in December 2010, the e-antigen is weakly positive, has not been turned negative. on May 11, 2011, the DNA rebound 2, 05E +05 doctor said that the virus mutated and produced drug resistance, drug resistance test rtL180M and rtM204V positive. rtM204V positive. On May 27, 2011, I started to take Adderall (Elavil) + Lamy (Herceptin) combination medication, and on June 24, my DNA was 2, 07E+04, and on August 2, my DNA was 5, 08E+02, with a reference value of <1000. Director Wang, the above is the course of my treatment. What kind of examination should I do next, how to know whether the treatment is effective or not, and how to find drug resistance at the earliest. Wang Zhenyu, Department of Infection, Tianjin Infectious Diseases Hospital: In March 2006, I found that I had triple III infection, and my liver function was normal at that time, so I didn't have any treatment. (Yu comment: at this time is not untreatable) October 06 check liver function is normal HBV-DNA2, 68 × 10 7 times, (Yu comment: at this time is not untreatable) July 07 glutamic propylene aminotransferase 57, HBV-DNA1, 18 × 10 7 times, the doctor gave me 20 days of five ester tablets liver function is normal. (Yu comment: at this time is not irresistible. (Yu comment: at this time is not unavailable antiviral) February 13, 08 glutamic acid transaminase 127, began antiviral treatment, used 3 months of interferon. (Yu comment: at this time is not impossible to Lamy) May 27, 08 HBV-DNA2, 94 × 10 of 7, the doctor said that interferon is not effective to change to lamivudine (Herceptin) + adefovir (Mingzheng) (Yu comment: at this time is not impossible to Lamy alone) after 2 weeks of HBV-DNA2, 15 × 10 of 4, 4 weeks after HBV-DNA2, 15 × 10 of 4. After 2 weeks, HBV-DNA2, 15 x 10 to the 4th power, after 4 weeks, HBV-DNA1, 94 x 10 to the 3rd power, due to economic considerations, stopped Lamy and took adefovir alone! (Yu comment: wrong! Should not withdraw Lamy) 6 weeks after the virus rebound HBV-DNA5, 41 × 10 6 times, and add Lamivudine April 09, DNA turned negative, he stopped the drug to take traditional Chinese medicine. (Yu comment: wrong! (should not stop the drug, not to mention Chinese medicine) November 17, 09 liver function abnormal glutamic acid aminotransferase 314, began to protect the liver to reduce the enzyme single service lamivudine, (Yu comment: right!) March 2010 DNA turned negative. December 2010 e antigen weak positive, has not turned negative. (Yu comment: time to add Adderall) May 11, 2011 DNA rebound 2, 05E + 05 doctor said the virus mutated to produce drug resistance, drug resistance test rtL180M and rtM204V positive. On May 27, 2011, I started the combination of Adderall (Elavil) + Lamy (Herceptin) (Yu's comment: Adderall is better than Herceptin). On June 24, DNA2, 07E+04, and on August 2, DNA5, 08E+02, the reference value was <1000. Dr. Wang, the above is the course of my treatment. May I ask what tests I should do next, how to know if the treatment is effective or not, and how to find out the drug resistance at the earliest. (Yu comment: do a quantitative E antigen, and then do a surface antigen diluted 400 times the experiment, the next step in the opportunity to withdraw Lamy, the interval again, the problem of laboratory tests, you can mail serum to me, two laboratory tests 100 yuan)