1, why antiviral therapy To date, there is no treatment or drug with satisfactory efficacy to cure patients with chronic hepatitis B. The fundamental reason is that the hepatitis B virus (HBV) in chronic hepatitis B patients continues to replicate and cannot be removed by the body’s immune function and therapeutic drugs. But in recent years, with the in-depth research on chronic hepatitis B, there has also been a major breakthrough, that is, antiviral therapy, which cannot completely remove the hepatitis B virus, but can maximize the inhibition of the virus, restore liver function, thus reducing hepatocyte inflammation necrosis and liver fibrosis, delaying and reducing the occurrence of cirrhosis, liver cancer and their complications. Therefore, antiviral therapy is the main treatment method for chronic hepatitis B at present. 2.How does the hepatitis B virus replicate In medicine, the reproduction of the virus is called “replication”. This is because unlike bacteria and parasites, it does not reproduce by nuclear division, but rather by following a certain mold, just like we cast machine parts. The hepatitis B virus has two keys in the replication process: one is HBV DNA polymerase, which exists in the core of the hepatitis B virus, and together with the hepatitis B virus core antigen (HBcAg), e antigen (HBeAg) and viral genes (DNA) constitute the core of the hepatitis B virus, its role is to “catalyze” the hepatitis B virus Its role is to “catalyze” the hepatitis B virus gene to replicate the spiral viral DNA chain according to a certain “template”. Without the action of this polymerase, hepatitis B virus replication would cease. The nucleoside antiviral drugs used in clinical practice now inhibit the hepatitis B virus DNA polymerase, thus inhibiting hepatitis B virus replication. Second, the hepatitis B virus gene (DNA) is a ring-shaped structure surrounded by two helical DNA strands. The two DNA strands are called the “positive strand” and the “negative strand”. The longer negative strand has formed a complete loop; the shorter positive strand is not closed and is semi-looped. After infecting the liver cells, this half-loop positive chain has to use the negative chain as a “template” to replicate and extend, forming a complete loop. In this way, the hepatitis B virus gene forms a completely circular double-stranded DNA, which we call covalent closed-loop DNA (i.e., cccDNA), which can be regarded as the “original template” for virus replication. After the “template” is formed, it will replicate one gene after another, forming negative and positive strands, and then assembling them together to form new hepatitis B virus DNA particles. This is how the hepatitis B virus keeps replicating, and the new viral genes are then released from the liver cells, infecting more liver cells and then entering the bloodstream. This “cccDNA” has a long life span, and once it is formed in the nucleus of the liver cells, it is highly stable, like a “weed root”, and is deeply “embedded” in the It is very difficult to remove completely, and currently can only rely on anti-viral drugs to inhibit their replication for a long time and consume them little by little (depletion). 3, how to know how much hepatitis B virus in the body The serum level of hepatitis B virus DNA is a reliable quantitative indicator of hepatitis B virus replication. The most commonly used method for detecting hepatitis B virus DNA is the “polymorphin chain” (PCR for short) technique, which is clinically used and is expressed in units of “10n copies/ml”. If the HBV DNA detected in the serum is ≥ 105 copies/ml, it means that the hepatitis B virus replication is more active and the amount of virus in the body is more. 4, the amount of hepatitis B virus replication can represent the degree of liver cell damage Many people with hepatitis B infection will be very frightened when they see a laboratory test HBV DNA > 105, > 106, > 107 copies / ml. Think about 105 is 100,000, 106 is 1 million, 107 is 10 million ……, each milliliter of blood “living” with so many “hepatitis B enemies”, that’s still! It’s a great idea! In fact, there is a large amount of hepatitis B virus replication in the body of hepatitis B patients every day, but the hepatitis B virus in the blood is also constantly being removed in large quantities every day. According to scientists who have studied the hemodynamics of the hepatitis B virus in humans, the half-life of the hepatitis B virus is 26.4 hours, and the daily renewal rate of the virus is 48%. In other words, half of the hepatitis B virus dies naturally or is removed from the body every day. The reason why the body cannot completely remove the hepatitis B virus is that the “cccDNA”, which is deeply embedded in the liver cells, cannot be completely removed by the immune function, which is the reason why hepatitis B virus carriers have an innate immune deficiency against the hepatitis B virus. In addition, the hepatitis B virus does not directly cause liver cell damage, but causes liver damage due to virus-induced immune dysfunction, and can also cause immune liver damage due to (alcohol, medication, overwork, cold, etc.) causing immune dysfunction and activating the virus. The amount of virus replication does not represent the extent of liver cell damage, and many HBV DNA-positive hepatitis B virus-infected patients have normal liver function, and the hepatitis B virus and the human body “coexist peacefully”. Therefore, the hepatitis B virus replication index should not be taken as a sign of liver damage, liver function is the main indicator of the degree of liver damage, but also liver puncture pathological examination, pathological indicators are the golden indicators to understand liver damage. Of course, hepatitis B virus carriers can not be paralyzed, regular laboratory tests are “necessary”. 5, what kind of hepatitis B patients need antiviral treatment chronic hepatitis B patients in the immune clearance period (that is, high replication of the virus, HBV-DNA positive, abnormal liver function, repeated fluctuations in transaminases between 100-300U), is the best time to antiviral, if asymptomatic hepatitis B virus carriers, the best liver puncture pathological examination to reduce blindness. Anti-viral treatment should master the best “opportunity”, in line with the principle of “people do not offend me, I do not offend, if people offend me, I will offend”. The hepatitis B virus is like the “enemy”, when the enemy does not invade “our side”, “our side” is to strengthen protection, regular monitoring. When the “enemy” virus replicates in large quantities, constantly harassing “our” side and causing damage to “our” liver cells and abnormal liver function, we can’t wait for it to happen. When the liver function is abnormal, we can’t take it lightly, then we should pick up the “weapon” of antiviral drugs to fight the “enemy”. 6, antiviral treatment includes which antiviral mainly refers to the western medicine interferon and nucleoside drugs. The main mechanism of action is: interferon creates an environment unfavorable to viral replication, indirectly inhibit viral replication; nucleoside analogues are directly inhibit hepatitis B virus DNA polymerase, to achieve the purpose of long-term inhibition of viral replication. The Chinese herbal medicine in the antiviral treatment objectively speaking there are no drugs that can surpass interferon and nucleoside analogues. (1) Interferon (IFN) is a broad-spectrum antiviral drug: interferon contains the main component is a glycoprotein, a cytokine produced by the body’s lymphocytes, it does not directly kill or inhibit the virus, its antiviral mechanism is to bind with cell membrane-specific receptors, producing an enzyme called “antiviral protein” in the cell It creates an environment that is not conducive to viral replication, thus interfering with and inhibiting viral replication and enabling the body to develop a defense system against viral infection. In addition, interferon can also enhance the immune function of the body. Interferons can be classified into three major classes: a, b, and g. They are produced by leukocytes, fibroblasts, and immune lymphocytes, respectively, and have antiviral, anti-cell division, and immunomodulatory activities. Interferon a is mainly used for anti-hepatitis B virus treatment, and the commonly used ones are a-1b, a-2a and a-2b. Interferon a (IFN-a): It has been used for the treatment of chronic hepatitis B for more than 20 years, but its effect is limited, and the general efficiency (referring to the negative serum HBV-DNA and HBeAg and the normalization of serum ALT) is 30%-40%, and the sustained efficiency is around 20%. The anti-HBV mechanism of action of interferon a is mainly to inhibit viral replication and regulate host immune function, but it is difficult to clear the virus and has a high relapse rate. Because interferon therapy requires daily or every other day long-term injection, and there are more adverse effects, such as flu-like symptoms, temporary leukocyte and platelet reduction, fever, hair loss, diarrhea, and fatigue, etc. Long-term use of individual patients can be complicated by hyperthyroidism, inter-rectal pneumonia, retinopathy, and anxiety and depression. How to improve the efficacy and reduce the side effects of interferon is the current hot spot of clinical research. The newly developed long-acting interferon, called pegylated glycol interferon a (PEG-a), is a combination of interferon a and pegylated glycol, which can significantly extend the half-life of interferon, thus maintaining the relatively stable antiviral activity of IFN in the serum, and can be injected once a week, which greatly improves the tolerability and compliance of patients, and shows greater advantages in clinical application. (2) Nucleoside analogues: they can directly inhibit the synthesis of hepatitis B virus DNA through different links, so as to achieve the purpose of inhibiting hepatitis B virus replication. The older generation of nucleoside antiviral drugs such as adenosine injection, due to poor efficacy, high toxicity, inconvenience, can not adhere to long-term medication. They are rarely used clinically. In the past 10 years, the new generation of nucleoside analogues have been widely used in patients with chronic hepatitis B in China due to their strong antiviral effects, low adverse effects, once-daily oral administration and convenience of use, and have now become a hot topic in the field of antiviral drug research. At present, the ones listed in China are lamivudine (Herceptin), entecavir, telbivudine, adefovir (Hovelix); the ones to be listed soon are tenofovir and clavudine. The four nucleoside analogues that have been used in clinical practice have their own advantages and shortcomings; for example, lamivudine and entecavir have rapid antiviral effects, but lamivudine has a high mutation rate for long-term application, entecavir is more expensive, tipifudine has more side effects, adefovir is slower to work, etc. 7, hepatitis B patients how to choose the correct antiviral treatment hepatitis B virus, the “enemy” is very cunning, we are fighting it, but also to pay attention to strategic tactics. Under the guidance of your doctor, you should choose a reasonable antiviral method based on the best clinical evidence of the patient and on careful consideration of the patient’s specific condition and his or her wishes. For example: young patients, ready to get married and have children, it is best to choose interferon antiviral, in 1 year-1.5 years can stop the drug, and the body’s ability to resist the side effects of interferon; middle-aged and above, need to adhere to work, can choose nucleoside (acid) analog antiviral; strong economic ability, the disease is more serious, can choose a strong and fast, the virus mutation rate of low drugs; economic ability Poorer, less severe, can choose a slower onset of action, the virus mutation rate of low drugs; can also be used in combination and so on. 8, hepatitis B patients how to correctly treat antiviral treatment in a clear indication, the correct choice of antiviral treatment, the patient’s active cooperation is needed to fight the “war of annihilation”. Because antiviral treatment is a “long battle”, we must be fully prepared to fight a protracted war, only to have a full understanding of antiviral treatment, “know yourself and your enemy” in order to effectively “annihilate the enemy The only way to effectively “destroy the enemy” is to have a full understanding of antiviral treatment and to “know your enemy”. During the treatment process, some relevant indicators should be tested regularly to minimize some avoidable side effects and complications. If necessary, some herbal treatments should be supplemented to reduce some side effects, such as: leukopenia, thrombocytopenia, hair loss, headache, body pain, abdominal distension, weakness, etc. In addition, patients who have been taking medication for a long time should also seek regular consultation with a specialist and ask for guidance from an experienced doctor on antiviral treatment, such as what to pay attention to, how to eliminate discomfort, how to monitor relevant laboratory tests, how to predict viral mutations, how to prevent hepatitis complications, etc.