What is the goal of hepatitis B treatment? At present, there is no specific drug for the treatment of hepatitis B, so doctors are concerned about how to minimize the damage caused by the hepatitis B virus to the human body, so in this regard, our country has also made a guideline on the prevention and treatment of hepatitis B. The guideline clearly states that the goal of the treatment needs to be long-term suppression, or even elimination of the virus. Through long-term suppression of the virus can eliminate the hepatitis B virus, hepatitis B virus infection caused by hepatocyte inflammation and thus control the progression of liver damage, and ultimately prevent the root of hepatitis B-related complications such as cirrhosis, hepatocellular carcinoma and cirrhosis, because these are affecting the quality of life of the people, including the quality of work and so on. Therefore, through the long-term suppression and elimination of the hepatitis B virus, we can achieve this goal, which can ultimately improve the quality of life and quality of work of people infected with hepatitis B. Therefore, it should be said that our country’s prevention and treatment of hepatitis B is very clear, that is, the suppression of the hepatitis B virus is necessary. In general, as a doctor, this is the main goal. So how long does the course of hepatitis B treatment usually take? This is a topic of concern for many people infected with the hepatitis B virus, that is, many patients say: how long do I need to be treated? In fact, there is no fixed course of hepatitis B treatment, we emphasize a so-called individualized course of treatment, that is to say, each person must be based on her response to treatment to determine her course of treatment. Our national guideline on the prevention and treatment of hepatitis B also points out the so-called stopping criteria, that is to say, for E-antigen positive people must have E-antigen seroconversion, E-antigen seroconversion includes E-antigen conversion and E-antibody positivity, and at the same time, the DNA has to be below the detection line, and the third aspect is that the life indexes, that is, the transaminases are normalized, and the three indexes are necessary to be achieved. After these three indicators have been achieved, the drug can be considered to be discontinued if the situation lasts for more than half a year. For E-antigen negative patients, since there is no more E-antigen index, accordingly, the evaluation index is the level of hepatitis B virus DNA and biochemical index, that is to say, both indexes have to be achieved, since there is no more E-antigen index to evaluate, so it is required that the viral DNA fall below the detection line and the biochemical index, that is to say, the aminotransferase is normal. After normalization, the drug can only be discontinued after continuous requirements have been met. However, it is important to note that these two indicators are only the minimum that we propose, and the doctor may actually extend the course of treatment, depending on the patient’s condition. In order to minimize recurrence, for E antigen-positive patients, treatment should be continued for at least six months after the stopping target is reached, and for E antigen-negative patients, at least one and a half years should be extended after the stopping target is reached. We are talking about the minimum time, so if it is longer, relatively speaking, it is better to consolidate the treatment for a longer period of time. Of course, some people have asked in the past: can I achieve the goal of surface antigen conversion? But in fact, this goal is very difficult at this stage, just as we often say, go to the competition to get the gold medal, but in fact the competition gold medal is only one person, so our hepatitis B treatment is the same, to achieve this surface antigen conversion is very rare. For us, it is more practical to emphasize what the guideline just mentioned: for E-antigen positive patients, to achieve a serological conversion of E-antigen and a reduction of DNA, as well as an improvement of biochemical indexes, as a doctor’s most hopeful, of course, to achieve this surface antigen conversion is the best outcome. The choice of drugs for hepatitis B treatment is very important, what are the recommendations for first-time patients? Nucleosides are very important because we all know that there are two problems with nucleoside therapy, one is the strength of viral suppression and the other is drug resistance. The other one is drug resistance. On the other hand, the drug resistance issue is related to the strength of viral suppression. Most of our experts now suggest that in order to reduce drug resistance, the initial treatment should be with a potent drug, so that the virus can be minimized in the shortest possible time, which can reduce the incidence of drug resistance over a considerable period of time. Therefore, if a patient is treated with a nucleoside analog, the initial treatment should be more effective in suppressing the virus. Of course, there are individual cases, the patient’s viral base is relatively low, and coupled with economic reasons, this is the so-called individualized. Of course, the general principle is that when choosing drugs, we hope that the virus can be suppressed to a minimum within a relatively short period of time. On the basis of this principle, most people tend to choose more potent drugs, such as telbivudine, entecavir, and so on, but of course, these are comprehensive considerations. How does the choice of the initial treatment drug affect the choice of long-term efficacy? It has an impact. There are two categories. For example, for E antigen-positive patients, the goal of treatment for E antigen-positive patients, one of the very important is the E antigen seroconversion, so that in the selection of drugs to take into account the E antigen conversion rate of the problem, if the drug has a very strong inhibitory effect on the virus, but he has never been able to achieve the seroconversion of the E antigen, from our point of view of the treatment can not be discontinued, the course of treatment is an unknown, but this is not the case. However, if we can make the patient reach seroconversion of E antigen in an effective treatment program, and then after a consolidation period of half a year to a year, we can stop the drug, of course, it is the greatest benefit to the patient. At present, these drugs we have recently seen is the global clinical trials, tibivudine in the E antigen seroconversion does have his advantage, so this is that for the E antigen positive patients can be considered in this regard, so the treatment of hepatitis B should be individualized to take into account the specific situation of each person, differentiated treatment. At present, there are many hepatitis B antiviral drugs, so how to evaluate the efficacy of a drug? Evaluation of efficacy has just been mentioned, in fact, how long a patient’s treatment course is limited. For E antigen positive patients, it is necessary to include three aspects: one is the serological conversion of E antigen, must achieve E antigen to negative, E antibody to positive; the second indicator is that the DNA should reach the detection line, at least undetectable; the third indicator is that the liver function, that is, the aminotransferase must return to normal. These three indicators for E antigen-positive patients must be achieved, in the nucleoside analogues can be considered the best efficacy. For E-antigen negative patients, only the hepatitis B virus DNA and liver function indicators are evaluated. These two criteria are actually the same as those for E antigen positive patients, DNA must reach below the detection line, liver function indicators must return to normal, and on this basis, consolidation of treatment is required, which is the efficacy to be achieved for E antigen negative patients. Now there are a lot of clinical studies have proved that the morbidity characteristics of different countries in different regions of the world are not the same, so what are the morbidity characteristics of hepatitis B in our country? Our country is actually similar to the whole of Asia, most of them are infected by mother-to-child transmission, a survey found that about 81% of the infected patients in our country belong to this kind of virus level is not too high, if you use the most sensitive method to detect the virus level is below 9 times, and the transaminase is more than 80, these patients about the global study on tibivudine found that, if the treatment of tibivudine for two years, the virus level is within the same range as that in other countries, the virus level is within the same range. The global study of tibivudine in these patients found that if they were treated with tibivudine for two years, the viral levels were below 9 times the normal, that is, below 1 billion, and the aminotransferases were above twice the normal, that is, for example, if the normal value was 40, the aminotransferases were above 80, and that the seroconversions of the E-antigens with tibivudine for two years were 47%, close to 50%, which is very good news for the patients, because this is also more than the seroconversion target of interferon, which is the global therapeutic target. This is a very good news for the patients because this exceeds the interferon seroconversion mark, which is the result of the global treatment. Although it is a global trial, in fact, nearly 70% of the people are from Asia, which should be said to be more in line with the overall condition of the Chinese people, if this does bring us a pleasant surprise, we patients, including doctors, can make more efforts in this area in the future, so that nucleoside analog therapy can bring more benefits! The correct concept of hepatitis B treatment? In fact, many patients know that our country is now very much advertising, chaotic all, finally leading to the patient and spend money and then personal aggravation, and finally the disease is not cured! This is a problem of standardization. At present, our national prevention and treatment guidelines are clearly put forward what kind of patients should be treated, it must be hepatitis active people need to be treated, so what is hepatitis activity? What is the standard? In our country generally requires that the liver function index transaminase reaches more than twice the normal value, for example, if the normal value is 40, the transaminase is above 80. The second requirement is a DNA level of more than 5 times 10 for E antigen positive patients and more than 4 times 10 for E antigen negative patients. For such patients, treatment is considered, with interferon and nucleoside analogs, depending on the specific situation and the specific treatment that we have talked about. Then for some so-called carriers with the virus, transaminases are normal, regular examination is normal, and the virus is also very high, transaminases are normal, such a case we do not recommend treatment, the main thing is that the effect of antiviral therapy for such patients is very poor, and even if it is said that the use of nucleoside analogues have harmful effects, originally carriers should not be treated, treatment after the emergence of drug resistance brings a The problem of drug resistance after treatment brings a big problem. We have just mentioned that the initial treatment is very important, and once resistance occurs after the initial treatment, it will bring a lot of trouble. Secondly, what should we do if we really want to treat the disease? Doctors suggest that a liver biopsy can be done to see if there is any inflammation and activity in the liver, and if a puncture of the liver is found to indicate that there is grade 2 or higher inflammation, treatment should be considered. Another point of reminder to the general public is to never listen to outside advertisements or personal recommendations, such as my recent outpatient clinic, I heard that some patients use Amway to treat hepatitis B, which is not at all reasonable. Can be adjusted through diet, but diet alone to treat hepatitis B to achieve the purpose of treatment, I personally think it is almost impossible. Summary: For the majority of patients, first of all, to understand the condition, you must understand your condition is how, even if you go to see a doctor, you must consult the doctor what degree of the condition, they must know the condition in order to go with the treatment. If you are indeed a carrier, then you follow the doctor’s advice, regular checkups, of course, sexual life should be moderated, of course, can not drink alcohol, etc.; if it is clear that chronic hepatitis B patients, is the need for treatment, then consider from all aspects, such as the decision to play the interferon, or nucleoside analogues of the drug treatment? If it is playing interferon, playing interferon side effects, inconvenience, if the nucleoside analogs have a course of treatment is not sure and drug resistance problems; if you choose the nucleoside analogs can be a strong inhibitor, as far as possible to reduce drug resistance, as far as possible to achieve the therapeutic purpose of a limited course of treatment, after all, we do not want to take medication for a long time, do not want to be accompanied by the drug for a lifetime, so I still hope to achieve the therapeutic purpose of a limited course of treatment, so that for the For hepatitis B-positive patients, I suggest using more drugs that can quickly achieve E antigen conversion, because E antigen conversion is a very important indicator for treatment.