A, the choice of antiviral timing 1, chronic hepatitis B diagnosis and treatment routine provisions: for slow hepatitis B, ALT greater than two times the normal value, that is, you can use nucleoside (acid) analogues (no upper boundary requirements). But some times, doctors or patients have to wait until the ALT drops to a certain level before considering antiviral therapy, in the clinic only to patients choose a lot of liver-protective drugs, even in patients can eat more than 5 two a day, also consider intravenous infusion, not knowing that this is the best time to antiviral. If you choose interferon for antiviral treatment, for slow hepatitis B, the diagnosis and treatment routine is also required, ALT 2 times or more, 10 times or less, you can start antiviral. However, in general, not the first choice of interferon single antiviral therapy. 2, from the follow-up history or from the hepatitis B two to half of the laboratory test (with titer), experienced doctors, can determine the patient about the time of infection, for mother-to-child transmission or young infected patients, they belong to the high-risk group, most cirrhosis, liver cancer patients are occurring in this group, should follow: early antiviral early benefit, late antiviral late benefit, not antiviral not benefit principle! If necessary, we can create conditions for antiviral treatment! For such patients, the timing of antiviral, can be more lenient, not necessarily ALT must be greater than 2 times the normal value, especially those patients whose age has exceeded 40 years. It is important to know that the period of immune tolerance (i.e. the period of non-response, when the ALT will remain in the normal range) is long, sometimes up to 30-40 years, for hepatitis B infection due to mother-to-child transmission. Therefore. Such patients must be examined at least 2-3 times a year at the time of the major triplet, in order to detect the immune response and timely antiviral treatment. 3, has been diagnosed with hepatitis cirrhosis early, or even already decompensated chronic hepatitis B patients, as long as the presence of the virus can be detected, should be immediately antiviral treatment to interrupt further deterioration of the disease. 4, correct a misconception: that small triplets must be a good thing, the correct concept should be: if the DNA negative, indicating that the disease in the quiescent period, to some extent is a good thing, if the DNA positive is a bad thing, indicating that, the patient has been infected with chronic hepatitis B for a long time, may have occurred in the hepatitis B virus before the mutation of the C region, equivalent to patients with large triplets. In this type of patients, the viral load is generally low, but there is more chance of developing liver cancer. The patient himself is known to carry the HBV-DNA. The patient himself has been known to carry the hepatitis B virus for more than twenty years and has no drinking habits, but was paralyzed by the lack of any discomfort and normal liver function tests and small triplets. A month ago, a physical examination revealed an occupying lesion in the right lobe of the liver and the patient sought medical attention. By that time, the liver cancer had grown to 10×200px. The patient had to undergo interventional treatment and hepatic lobectomy successively. After the operation, the patient had severe infection with a temperature as high as 40 degrees, considering the combination of sepsis, and the infection had not yet been controlled. There are many such cases and the majority of patients should be alert! It is important to know that patients with slow hepatitis B do not develop hepatitis cirrhosis, ascites or digestive bleeding occurs, in general, patients do not feel any discomfort, therefore, everyone should have regular medical checkups, in addition, to patients with slow hepatitis B, in addition to regular liver function, hepatitis B two to half, do not forget to check the HBV-DNA quantification! 2. The following people belong to the high-risk group for cirrhosis and liver cancer and must be treated as early as possible. (1) Mother-to-child transmission, those infected in early childhood. (2) Those who have a family history of liver cancer occurrence. (3) Those who are hepatitis B virus carriers and drink a lot of alcohol for a long time. (4) Patients who are already in the early stage of hepatitis cirrhosis, or even in the late stage. (5) Those who have hepatitis B infection combined with hepatitis C virus infection. (6) Those who are old and have low immune function. (7) Some data show that hepatitis B virus resistance occurs, especially those with A181 resistance site mutation are more likely to develop cancer. The first is that the patient’s DNA load is generally high and the treatment with interferon alone will not achieve satisfactory results. 2, the big three Yang patients, the choice of adefovir alone to treat is wrong, one is prone to drug resistance, and secondly, this drug has a certain degree of nephrotoxicity, long-term use of more than 6 years, some patients will occur nephrotoxicity. In fact, because this drug belongs to nucleotide analogs, it is the only drug that has no cross-resistance with nucleoside analogs (tenofovir is currently available, not covered by medical insurance, and expensive), and should be more suitable for combination therapy with nucleoside analogs (entecavir, telbivudine, lamivudine) when resistant strains occur. Clinicians should also have the right understanding to protect this variety. 3. For patients with major triplets, combination therapy with nucleoside analogs and interferon is the direction: it can achieve the effect of shortening the time of conversion to minor triplets and avoiding the occurrence of drug resistance. However, some patients are not suitable for interferon therapy for various reasons, then the initial drug selection should be more appropriate. 4, for patients with small triplets, unless you have the possibility to get a gold medal and achieve clinical recovery indicators, it is not advocated to use interferon alone, especially long-acting interferon (imported) for treatment, because this is not cost-effective. 5, I do not advocate the use of nucleoside analogues and interferon combination therapy when the initial antiviral treatment, should you should first understand how the patient responds to a drug, and then further decide the following decision. Fourth, the timing of discontinuation of misconceptions 1, chronic hepatitis B antiviral therapy requires a long course of treatment, generally 3-5 years, for patients with major triplets, can reach the goal of the second step of antiviral therapy E antigen seroconversion has been very good. However, to achieve this goal, there is no recovery, and consolidation is needed, and it is possible to stay with only one nucleoside analogue treatment. In the past, the treatment routine of each country stipulates at least one year of consolidation, but at present, the newly revised treatment routine of the United States has been extended to 3 years, but I think that it should be longer, after long-term maintenance, it is expected to achieve the ideal goal of surface antigen negative conversion. 2, as long as the surface antigen has not turned negative, or even if the surface antigen has turned negative, but the surface antibody has not yet appeared, or although it appears, the titer is very low, below 2 digits, it is best not to hastily stop the nucleoside analog therapy, otherwise there is still the possibility of relapse. 3, for patients with minor triplets, the best goal of treatment in all countries is the surface antigen negative, not just to achieve normal liver function, DNA negative, because this goal of treatment initially, if you choose the right drugs, as long as three months to six months can basically be fulfilled, is very easy to work, but only the surface antigen seroconversion (surface antigen to negative, surface antibody positive turn), is not easy to relapse Therefore, the treatment course needs to be longer. Therefore, the treatment course needs to be longer. Five, doctor-patient cooperation, work together to overcome the disease Currently, the treatment of chronic hepatitis B has made great progress. If early detection and early treatment can not affect marriage, childbirth, and even life expectancy. At present, many patients have achieved clinical recovery after reasonable treatment. Moreover, new drugs to cure CCCDNA are being researched abroad, but successful research and clinical marketing are still a long way off. The majority of hepatitis B patients, establish confidence, serious treatment, in order to achieve the best treatment effect, early health!