Hepatitis B is a common disease in China, is the most important cause of liver cirrhosis, liver cancer, and its treatment so far there is no effective treatment; in the face of hepatitis B, patients often feel confused, at a loss, and many people do not even know that they have been infected with the hepatitis B virus without realizing it, so how can we find hepatitis B early and give reasonable treatment? 1.How is the hepatitis B virus transmitted? Is Hepatitis B contagious by shaking hands and kissing in our daily life? Thank you! This is a clichéd question and one that is really misunderstood! Regarding the transmission of the hepatitis B virus, national and international experts have so far agreed that the hepatitis B virus is transmitted through body fluids and blood, that is to say, the hepatitis B virus can be transmitted only when the body fluids and blood of a healthy person come into contact with the body fluids and blood of a person who is infected with the hepatitis B virus, either directly or indirectly. Currently, there are many misconceptions that hepatitis B is contagious at meals, mainly because of the “family aggregation phenomenon” of hepatitis B infection. In fact, the transmission of hepatitis B virus among family members is not transmitted through meals, but indirectly through occasional sharing of toothbrushes, razors, women’s underwear during menstruation and other family members washing clothes and contaminated furniture; as for the kissing infection basically does not exist, only in the case of mouth ulcers on both sides of the kissing will occur, because there is no virus in the saliva; and handshake transmission of hepatitis B! It is even more impossible to say! 2. What are the chances that a child born to parents with hepatitis B will be infected with hepatitis B? Can expectant mothers with hepatitis B take some measures during pregnancy to avoid infecting the fetus? This is a particular concern for many couples of childbearing age. For fathers, whether or not they have hepatitis B basically does not affect the transmission of hepatitis B to their children. Transmission of hepatitis B from fathers to their children often occurs after the birth of the children, but nowadays, children will be vaccinated against hepatitis B as soon as they are born, which can play a protective role, so there is no need to worry about the transmission of hepatitis B from fathers. However, the influence of the mother with hepatitis B on the child’s transmission is very important. A mother with Hepatitis B “Triple Positive (Hepatitis B Virus E Antigen Positive)” will infect 99% of her children if she doesn’t take any precautions, but of course, if the mother is Hepatitis B Virus E Antigen Negative and HBV DNA Negative, the chances of her children being infected is very low; overall, the higher HBV DNA in the mother’s blood; overall, the higher the HBV DNA, the higher the chance of transmission. Regarding the measures to prevent transmission of hepatitis B to the fetus during pregnancy of mothers-to-be with hepatitis B, the 2010 edition of China’s hepatitis B prevention and control guidelines has clearly stated that: newborns of HBsAg-positive mothers should be injected with hepatitis B immunoglobulin of more than 100 IU and recombinant yeast hepatitis B vaccine of 10 mg (or Chinese hamster oocyte hepatitis B vaccine of 10 mg) into the outer muscles of the anterior gluteal area of both sides within 12 hours after birth, and then 1 hour after birth. 10 mg), and the 2nd and 3rd doses of hepatitis B vaccine at 1 and 6 months after birth, respectively; if newborns receive hepatitis B immunoglobulin and hepatitis B vaccine within 12 hours of birth, they may be breastfed. With the above treatment, about 90% of newborns can avoid hepatitis B transmission. As for the 10% of newborns who are not prevented, it is mainly due to the fact that hepatitis B transmission occurs during pregnancy, which is called “intrauterine infection”, and for “intrauterine infection”, it was once recommended that mothers-to-be with hepatitis B should be injected with 200IU of hepatitis B immunoglobulin every month for three months after pregnancy. For “intrauterine infection”, it was once recommended that mothers-to-be of hepatitis B should be injected with hepatitis B immunoglobulin 200 IU per month for three months after pregnancy. In fact, 200 IU of Hepatitis B Immunoglobulin is enough to clear the Hepatitis B virus for newborn babies, but for adult mothers-to-be, it is a “drop in the bucket” and does not have the slightest effect. A recent small sample study in China and Korea also found that 100% of newborns receiving hepatitis B vaccine and hepatitis B immunoglobulin were protected from hepatitis B virus transmission if they received antiviral treatment with tibivudine in the third trimester of pregnancy due to the need for treatment of the disease in the mother-to-be with active hepatitis. Of course, unless the mother-to-be’s condition requires treatment, the above practice is generally not advocated. 3.What are the most vulnerable groups of Hepatitis B? If you suspect you are infected with Hepatitis B virus, how should you be tested? Is there any window period? As far as China is concerned, the high-risk groups of hepatitis B mainly include newborns, infants and young children, unimmunized people under 15 years of age who are negative for hepatitis B surface antibody, once the above groups are infected with hepatitis B virus, the chances of chronicity will be higher, especially for newborns, which can be as high as 90%; other high-risk groups include: medical personnel, people who are often in contact with blood, staff of child care institutions, organ transplant patients, people who often receive blood transfusion or blood products, people who receive chemotherapy, and people who are frequently infected with hepatitis B virus, and people who receive chemotherapy. Other high-risk groups include: medical personnel, personnel with frequent contact with blood, personnel working in child care institutions, organ transplant patients, people who often receive blood transfusion or blood products, people who receive chemotherapy, immunosuppressive therapy and immunocompromised people, people prone to traumatic injury, family members of HBsAg-positive people, male homosexuals or people who have multiple sexual partners, and people who inject drugs into veins. If hepatitis B virus infection is suspected, it can be clarified by checking hepatitis B surface antigen and E antigen. If the surface antigen and E antigen are positive, there is definitely hepatitis B virus infection, and further checking of liver function, HBV DNA, E antigen quantification, ultrasound and FibroScan are needed; if the surface antigen is positive but the E antigen is negative, further checking of HBV DNA is needed, and if HBV DNA is higher than 1000 copies/mL (or 200 IU/mL), further tests as described above are also needed. In case of chronic infection, there is no “window period”; in case of acute infection of hepatitis B, there is a “window period”, which is usually called “incubation period” in medicine. The incubation period of hepatitis B is large, the short one month, the long one can be as long as 4 months. 4. Is the medical trilogy of “hepatitis B – cirrhosis – liver cancer” the inevitable development process of hepatitis B patients? How to correctly face the medical “trilogy”? Hepatitis B is the main cause of liver cirrhosis and liver cancer, but the “Hepatitis B – Cirrhosis – Liver Cancer” trilogy is not the inevitable experience of every patient infected with hepatitis B virus, and those who have the above developmental process are only a minority after all. Epidemiologic investigation shows that among untreated hepatitis B infected patients, the annual rate of cirrhosis in asymptomatic virus carriers is only 0.9%, and the annual chance of cirrhosis in patients with chronic hepatitis is not more than 3%. The majority of liver cancers originate from cirrhosis, but the incidence is quite low: asymptomatic carriers and chronic hepatitis patients have an annual incidence of liver cancer of no more than 0.6%, and even if cirrhosis develops, the annual incidence of liver cancer is no more than 4%. For hepatitis B infected patients who have no liver cancer family, low virus or receive antiviral treatment, the possibility of liver cancer is even lower. Therefore, hepatitis B patients do not need to worry about the hepatitis B trilogy, what is important is that we should have the right response. About how to prevent liver cancer and cirrhosis complications from occurring at an early stage, there is a detailed introduction in my personal website article. 5. How to control the condition of Hepatitis B and prevent it from further development? What are the current treatments for Hepatitis B? How do you think about whether Chinese medicine is reliable in treating hepatitis B? Furthermore, many patients are consuming liver-preserving and liver-protecting health supplements, is it necessary? It should be noted that not all Hepatitis B virus infections cause liver damage, thus it is necessary to find out whether there is any liver damage before considering the control of the disease. A simple way to find out if there is liver damage is to check the aminotransferases (TT) regularly. Generally, hepatitis B infected patients under 30 years of age are required to have their TT checked every 3 months, if the TT is normal, no treatment is needed. If the TT is elevated and the virus cannot be cleared by liver protection treatment for 6 months or so, then the degree of liver damage needs to be further examined, and ultrasound and FibroScan tests can be considered. If the ultrasound reveals splenomegaly without hematological disease, cholecystitis without gallstones, and cirrhosis, or if the liver elasticity value exceeds 9.8 kPa by FibroScan, antiviral therapy should be considered to control the progression of the disease. For those who have never been examined before and are over 30 years of age, especially those who are E antigen negative, have HBV DNA higher than 10,000 copies/mL (or 2,000 IU/mL), or who are over 40 years of age, a thorough examination should be done, and antiviral treatment is also needed if there are any of the above mentioned problems, and if the above examination does not clarify the status of the disease, then liver puncture is necessary to clarify the status of the disease. For the control of disease development, the main emphasis is on antiviral treatment, including interferon and nucleoside (acid) oral drugs, the latter requires long-term medication, and should not be discontinued without authorization, young patients or patients with reproductive requirements need to be carefully considered, and should not decide to use it hastily; the other treatments include hepatoprotective drugs, anti-fibrotic drugs and traditional Chinese medicine treatment. Traditional Chinese medicine is the characteristic of hepatitis B treatment in China, but for patients who need antiviral treatment, it is important not to emphasize the traditional Chinese medicine treatment and neglect the antiviral treatment, especially for patients who have progressive liver fibrosis or cirrhosis, antiviral treatment is crucial. For health supplements, there is no relevant research showing the anti-hepatitis B therapeutic effect of health supplements, and in my opinion, I do not advocate the use of health supplements. It should be especially emphasized that patients infected with hepatitis B must be prohibited from drinking alcohol, especially long-term alcohol abuse, even if hepatitis B has been controlled, it is necessary to emphasize the cessation of alcohol. 6. Nowadays, many hepatitis B patients are pursuing “turning negative”, are “turning negative” and “curing” the same thing? Can hepatitis B be cured? Conversion” is an important goal in the treatment of hepatitis B, but it should be set realistically. In the existing hepatitis B treatment, if the hepatitis B E antigen is positive, the goal of the treatment should be to pursue “E antigen conversion”, “HBV DNA conversion” and “E antibody conversion”, of course, normal liver function is also the goal; of course, normal liver function is also the goal. Of course, normal liver function is also the goal; if E antigen negative, then pursue “HBV DNA negative” and normal liver function; as for the dream “surface antigen negative” (the so-called “cure”), in fact, it is not possible. As for the dream of “surface antigen conversion” (the so-called “cure”), it is actually an unattainable goal. In the current treatment method, although 1 year of long-acting interferon can make about 8% of patients with surface antigen turn negative, but even for patients with surface antigen turn negative, after using immunosuppressant for other diseases, there will still be recurrence of the disease, surface antigen or even E antigen turn positive, therefore, it is still impossible for the existing treatment of chronic hepatitis B to pursue the complete “cure”, and it can only pursue the goal of stopping the drug and stopping the drug. Therefore, the existing chronic hepatitis B treatment still can’t pursue complete “cure”, and can only pursue “stabilization” after stopping the drug. After stopping the drug, regular examination is still needed to confirm that HBV DNA is at a low level (less than 10,000 copies/mL), and the liver is not harmed. 7, talk about a few common misconceptions about hepatitis B: a) I had hepatitis B before, but now my liver function is normal, including hepatitis B DNA virus test is also normal. Doesn’t it mean that hepatitis B has been cured and won’t recur? If there is no treatment and surface antigen turns negative and surface antibody turns positive in natural state, it can be regarded as “hepatitis B is cured” and will not recur without using immunosuppressant; however, if hepatitis B surface antigen is positive, it cannot be regarded as “cured”. b) Is “minor triple positive” less dangerous than “major triple positive”, so there is no need to rush for treatment? If HBV DNA is positive, “mini-positives” may be more dangerous than “maxi-positives”. Generally speaking, patients with “Minor Triple Positive” must have experienced a war between the immune system and the Hepatitis B virus, and the end of this war is to cause the Hepatitis B virus to “die with the liver cells”, compared to “Major Triple Positive”. Compared with “major triple positive”, “minor triple positive” will have more wars, and thus the damage to the liver will be heavier; in the clinic, we can also see that the incidence of cirrhosis of “minor triple positive” patients is higher than that of “major triple positive” patients. The incidence of cirrhosis in patients with “minor triple positive” is higher than that of “major triple positive”. Therefore, for patients with “minor triple positive”, HBV DNA must be checked, and if HBV DNA is higher than 10,000 copies/mL, they must be treated according to “major triple positive” and undergo a detailed examination to determine the degree of liver damage, and start treatment as early as possible if antiviral treatment is necessary. If the liver function is normal and antiviral treatment is not necessary for the time being, the period of regular examination should be shortened to 3 months. c) Is it right that hepatitis B antiviral treatment should be used for a lifetime? Whether hepatitis B antiviral treatment needs lifelong medication depends on the state of liver damage. If the disease has developed to the decompensated stage of cirrhosis, such as ascites, severe jaundice, upper gastrointestinal bleeding and other manifestations, then antiviral treatment needs to be lifelong medication because most of the disease will recur after stopping the medication, and the consequences will be very serious if it is not dealt with in time, and some patients will even go to the point of no return; even if the disease is detected and treated in time, the previous efforts of the treatment will also be wasted. As for compensated cirrhosis, although long-term medication is advocated, after long-term treatment to eliminate the virus, if the condition is stable after stopping the medication, it is possible to stop the medication with confidence under the premise of regular testing. For ordinary hepatitis, once the treatment goal is achieved and after consolidating the treatment for a period of time, it is also possible to stop the drug. It should be emphasized that, regardless of the condition, it is necessary to adhere to the regular examination every 3 months for 1-2 years after stopping the medication, and shorten the interval between examinations if necessary, so as to detect and treat the possible recurrence of the condition in time. d) Is it correct to say that patients with hepatitis B do not need to be examined and treated if they have no symptoms? This is an extremely wrong statement! The liver is a silent organ that silently endures the ravages of Hepatitis B and only shows symptoms when it can’t take it anymore. We often see some seemingly “healthy” patients, once the onset of the disease will not be able to fall ill, this is a typical performance. In any case, once hepatitis B infection is detected, liver function indexes should be checked regularly, and whether there is any hepatitis activity should be recognized through regular monitoring of transaminases. If hepatitis activity is repeated for more than half a year, and the virus has not been eliminated, the necessity of antiviral treatment should be considered. About how to deal with hepatitis B virus infection, there are detailed suggestions in my website articles for patients’ reference. 8, expert message: Hepatitis B is not terrible, terrible is our understanding of hepatitis B misunderstanding! Hepatitis B diagnosis and treatment, must adhere to the principle of science, must go to the regular hospital for diagnosis and treatment, do not trust the ads, folk remedies, otherwise the people hurt and sad! Not all hepatitis B patients will develop into cirrhosis and liver cancer! Take control of hepatitis B and live happily!