The continued replication of the hepatitis B virus in the liver has the potential to put hepatitis B patients through three stages: hepatitis, cirrhosis, and liver cancer. Therefore, treating hepatitis B and delaying disease progression requires a holistic view. In the panorama of hepatitis B treatment, cirrhosis and liver cancer are the final stages of chronic hepatitis B progression. Effectively reducing the occurrence of cirrhosis and liver cancer has become the focus of attention for hepatitis B patients. Zhang Zhaolan, Department of Spleen, Gastrointestinal and Hepatobiliary Diseases, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
Hepatitis B, cirrhosis and liver cancer are in the same lineage
Professor Wang Yuming of the Department of Infection at Chongqing Southwest Hospital points out, “Chronic hepatitis B is a gradual process. It is like a volcano or earthquake at the bottom of the sea that is not easily detected, so some patients do not experience the obvious process of chronic hepatitis B before suddenly becoming cirrhotic, and some patients are not even detected until they reach the decompensated stage.” When hepatitis B inflammation occurs, it damages liver cells, and the body replaces some of the liver tissue with fibrous connective tissue during the repair process. If liver cells undergo long-term inflammatory necrosis, it stimulates excessive proliferation of fibrous tissue in the liver, which eventually leads to liver fibrosis, followed by cirrhosis and liver cancer. In this sense, hepatitis, cirrhosis and liver cancer are one and the same.
Viral replication runs throughout the progression of hepatitis B
Viral replication is the underlying cause of disease progression. An important study conducted in Taiwan over 13 years found that hepatitis B virus replication is not only closely related to the progression of chronic hepatitis B, but is also directly related to the development of cirrhosis and hepatocellular carcinoma. Professor Wang Yuming of the Department of Infection at Chongqing Southwest Hospital pointed out, “Hepatitis B virus is the root of all evil and the only dominant factor in the development of cirrhosis and liver cancer, and as long as there is hepatitis B virus replication, the trilogy of hepatitis, cirrhosis and liver cancer is prone to occur. Conversely, it is less likely to occur.”
Current antiviral therapy, whether interferon or oral nucleoside (acid) analogs, cannot directly kill the hepatitis B virus, but can achieve the goal of inhibiting viral replication and reducing the virus in the body to an unmeasurable degree. However, once antiviral therapy is discontinued, most patients with hepatitis B will experience a relapse and the hepatitis B virus will replicate again in large numbers. The liver repeatedly goes through such a vicious cycle of “treatment-discontinuation-relapse”, which may aggravate the progression of cirrhosis and even the occurrence of liver cancer.
Antiviral treatment can slow down disease progression
The new edition of the Guidelines for the Prevention and Treatment of Chronic Hepatitis B clearly states, “The overall goals of chronic hepatitis B treatment are to maximize long-term suppression of HBV, reduce hepatocyte inflammatory necrosis and liver fibrosis, and delay and reduce the occurrence of liver decompensation, cirrhosis, HCC and its complications, thereby improving quality of life and prolonging survival time.”
Among them, antiviral therapy is key and should be administered as soon as indicated and conditions permit.
For patients with early cirrhosis, timely antiviral treatment can reduce the risk of severe cirrhosis and even reverse early cirrhosis; early antiviral treatment in advanced cirrhosis can help to relieve the disease and reduce the effect of liver transplantation; for patients with liver cancer, antiviral treatment can also reduce the incidence of death and prolong For liver cancer patients, antiviral treatment can also reduce the incidence of death and prolong patients’ lives. In the past, without antiviral treatment, once a patient developed cirrhosis, death would occur in more than 80% of patients within 5 years,” Professor Wang emphasized. In contrast, the same patients receiving antiviral therapy have a mortality rate of less than 20%. Antiviral therapy extends the life of the patient by curbing viral replication.” In the case of lamivudine, for example, the incidence of liver cancer was reduced by nearly half in patients with cirrhosis who adhered to antiviral therapy for three years, and some early cirrhosis was completely reversed by adhering to treatment for 10 years, taking off the cap of cirrhosis. Therefore, antiviral therapy can slow down the disease progression at all three stages mentioned above and benefit patients.
Author: Collaborative Group Office Source: Beat Hepatitis B Network
Support Us
Discussion
Share your experience, or seek help from fellow patients.
