There are approximately 93 million people living with the hepatitis B virus in China. The reasonable and appropriate management of people living with the hepatitis B virus is not only a medical issue, but also an important social issue. If you are a hepatitis B carrier, what should you do? Should you believe in all kinds of advertisements about “turning negative”? Or should you avoid the reality of the disease and avoid treatment? As a long-time hepatology clinician, today I will tell you how to treat hepatitis B virus carriers with a scientific attitude. 1, the definition of hepatitis B virus carriers: More than 20 years ago, hepatitis B virus carriers were called “healthy carriers”, and later renamed “asymptomatic carriers”. In the guidelines for the prevention and treatment of chronic hepatitis B jointly developed by the Chinese Medical Association’s Liver Disease Branch and the Infectious Diseases Branch in 2005, it was pointed out that hepatitis B virus carriers are divided into two categories: serum HBsAg and HBV
DNA-positive, HBeAg or anti-HBe positive, but with more than 3 consecutive follow-ups within 1 year and serum ALT and AST in the normal range, are chronic HBV carriers; serum HBsAg positive, HBeAg negative, anti-HBe positive or negative, HBV
DNA undetectable (PCR method) or below the minimum detection limit, with more than 3 consecutive follow-ups within 1 year and ALT all in the normal range, are inactive HBsAg carriers. In other words, the most fundamental indicator to distinguish these two types of carriers is HBV
DNA. 2.Is the liver of hepatitis B virus carriers healthy? Most of the hepatitis B virus carriers have no obvious abnormalities in liver histological examination, but there are some liver tissues with obvious lesions. Since April 2006, Beijing Ditan Hospital has launched an outpatient clinic for hepatitis B virus carriers and performed liver puncture more than 300 times. The results of liver puncture in the first 65 cases of carriers with normal liver function showed that: inflammation grade
G≥2 in 25 cases, accounting for 38.5%, and fibrosis stage
The liver pathology of 13 carriers with family history of hepatitis B: 8 cases with G ≥ 2 (61,5%) and 5 cases with S ≥ 2 (38,5%). This shows that the liver of some hepatitis B carriers is not completely healthy, but there is obvious inflammation and fibrosis, especially in patients with a family history of hepatitis B. 3. Misconceptions about hepatitis B carriers: In clinical practice, there are two major misconceptions about hepatitis B virus carriers. The most common one is that “carriers are safe and do not need treatment”, and often do not pay attention to regular follow-up, so that some carriers 10 or 20 years later progressed to cirrhosis, liver cancer, or even to the late stage of liver cancer before being discovered, losing the best time for treatment. On the other hand, patients with positive HBVDNA and hepatitis B virus replication are blindly treated with antiviral drugs regardless of their liver function, which results in an insignificant decrease in HBVDNA and unsatisfactory antiviral effect, but easily leads to drug resistance. Therefore, hepatitis B virus carriers should be managed in a scientific manner, with the aim of timely screening out cases where the liver does have lesions, or where lesions have progressed and require treatment, and early detection of liver cancer cases, while for those with stable disease, avoiding blind drug use and drug resistance caused by inappropriate drug use, and reducing medical resources and economic waste. 4.Management methods of hepatitis B virus carriers: The management method of hepatitis B virus carriers mainly lies in follow-up monitoring. Through strict and standardized long-term follow-up, we can avoid blindly using drugs for patients who do not need treatment, and not to miss patients who need treatment. (1) Follow-up interval: For those with normal continuous ALT and negative HBV DNA, it is recommended to follow up every 6-12 months. For those with normal ALT but HBV
DNA-positive patients, it is recommended to test once every 3-6 months. 2) Follow-up examination items: should include liver function, HBV DNA, AFP, and ultrasound. In case of HBV
DNA-positive chronic HBV carriers, liver aspiration should be performed. Especially for those who are over 40 years old, have a family history of hepatitis B, transaminases at the high limit of normal, and abdominal ultrasound suggesting diffuse liver lesions or enlarged spleen, it is best to mobilize them for liver aspiration examination to further clarify the liver lesions and treat them accordingly as appropriate. (3) Carriers requiring antiviral therapy: carriers with liver puncture results showing inflammatory grade G ≥ 2 or significant fibrosis need antiviral therapy; once the ALT is found to be elevated more than 2 times the upper limit of normal during follow-up, and alcohol and drugs are ruled out as the cause, and at the same time HBV
DNA positive, antiviral treatment is required. 5, notes on the management of hepatitis B virus carriers: 1) maintain a normal mentality: the vast majority of carriers can work and live like normal people, only a few need treatment, therefore, you should put down the burden of thought and maintain a normal mentality. 2) Insist on long-term follow-up: Although a very small number of hepatitis B virus carriers can have a natural negative transformation of HBsAg, the vast majority of carriers carry the virus for life, so the follow-up of carriers should emphasize its long-term and lifelong nature. Never relax your vigilance with the extension of time. 3) Avoid risk factors: Hepatitis B virus carriers often develop abnormal liver function and inflammation of liver cells due to exertion, alcohol abuse, and taking liver-damaging drugs, thus turning into chronic hepatitis patients. Therefore, bad habits should be corrected and the diet and living should be regular. (4) Specialist hospital consultation and treatment: Do not blindly believe in the advertisements of some drugs that advocate “turning negative”, it is advisable to take a cautious attitude, whether to use antiviral treatment is best to go to a specialist hospital after a comprehensive examination and evaluation, under the guidance of experienced physicians.