Li is 28 years old and came to see me in the clinic for hepatitis B eight years ago. After six months of treatment with generic interferon from China, Li’s viral load remained unchanged. I advised him to take lamivudine combined with adefovir for treatment, and the combination of the two drugs was very effective. Four months after taking the drugs, Li’s liver function returned to normal, and his HBVDNA was below the lower limit of detection after nine months, and his major triple positive was converted to a minor triple positive after one and a half years. I suggested that Li continue to consolidate treatment for three years before considering stopping the drug for observation. Because he was worried about relapse after stopping the medication, Li continued the treatment for five and a half years before stopping the medication for observation. One month after stopping the medication, the test results showed that Li’s HBVDNA quantitatively increased to three-tenths of a copy, but his liver function was still normal. Two months after stopping the medication, Xiao Li’s HBVDNA quantification rose to six copies of ten, and his gammaglutamyltransferase rose to more than 300, so I suggested that Xiao Li restart antiviral therapy immediately and start taking domestic entecavir treatment. Mr. Li was very depressed and asked me sadly, “Dr. Wang, I have already changed to small triple positive and have been on consolidation therapy for five and a half years, so why did I relapse as soon as I stopped taking the medication? Do I really need to take medication for the rest of my life?” It is indeed not very easy to make this question clear. Starting from the relevant guidelines, the latest version of China’s hepatitis B guidelines recommend that patients with triple major need to take medication for at least four years, and at least three years of consolidation therapy after the major triple to minor triple major before they can consider stopping the medication for observation, and at the same time it is clearly pointed out that: prolonged consolidation of the treatment time can reduce the recurrence of the disease. Xiao Li has been consolidating treatment for five and a half years, it is reasonable to stop the drug observation, but the reality is merciless, Xiao Li a stop the drug hepatitis attack! Is the hepatitis B guideline wrong? More and more clinical studies have shown that after oral antiviral drugs for patients with hepatitis B, even if the patient has turned into a small triple positive and has been on consolidation therapy for more than three years, there are still up to 70% of patients with hepatitis flare-ups after discontinuing the drugs, and once the flare-up occurs, the previous work is over and you have to do it all over again. Currently recognized as a reliable standard for stopping medication is to take medication until the hepatitis B surface antigen turns negative, to achieve this goal, most patients need to take medication for more than ten years or even longer. The 2015 version of the U.S. guidelines explains the issue of the course of treatment for hepatitis III in this way: the course of oral antiviral medications in HBeAg-positive patients is recommended to be lifelong treatment with nucleoside (acid) analogs for all patients with decompensated cirrhosis at baseline, and for the majority of patients who have significant liver fibrosis (F3) or compensated cirrhosis (F4) at baseline. Patients with compensated liver disease at baseline may be considered for discontinuation of therapy if there is a conversion to hepatitis B surface antigen (please note: it is hepatitis B surface antigen that is negative) lasting more than 6 – 12 months or if hepatitis B surface antibodies are present during the course of therapy. The U.S. Hepatitis B Guidelines also provide a detailed explanation: Hepatitis B triple III patients with liver histologic evaluation below F3 are traditionally considered to have HBeAg seroconversion that predicts a durable response, and it is recommended to continue consolidation of treatment for 12 months after HBeAg seroconversion (triple III to triple III) can be considered for discontinuation of treatment. However, clinical observations have shown that many, if not most, hepatitis B patients who discontinue therapy at the end of consolidation will experience a hepatitis flare. Therefore, the U.S. guideline clearly points out that even if the major tri-positive has been converted to minor tri-positive, and after more than one year of consolidation therapy, the continuation of treatment should be considered. Discontinuation is not recommended for patients who have not yet experienced a hepatitis B surface antigen conversion. (Recently, I asked a famous Chinese hepatitis B expert, Prof. Luo Xian from Guangzhou Southern Hospital, about this issue, and Luo replied: There are some problems, and my understanding is gradually changing. At present, there is no recognized standard for stopping medication, “triple positive” hepatitis after treatment to “small triple positive”, consolidation of 3 years, most of them will rebound. After stopping the medication until the surface antigen of hepatitis B becomes negative, the current limited experience found that there are still many rebound cases, and the surface antibody of hepatitis B appears, and the antibody concentration is more than 100mIU/ml, and the medication is discontinued after maintaining it for 2 years, so I don’t know how to …… The road to oral antiviral therapy for chronic hepatitis B is a long march in the truest sense of the word. Once hepatitis B patients start taking medication, they must be prepared to fight a long-lasting war and be psychologically prepared to take medication for more than ten years. As the old saying goes, as long as we can live a long and healthy life, as long as we don’t develop cirrhosis or liver cancer, what does it matter if we take medication for a long time or even for life? The purpose of taking medication is to maintain our health, so don’t take stopping medication as the goal of treatment.)