New Concepts in Hepatitis B Treatment1

Xiaohong (a pseudonym) is a Beijing girl, when she was 5 years old, a routine physical examination found that she is ao anti-positive (commonly known as “hepatitis B triple positive”), because of the fear of being discriminated against, has been hidden. In her first year of high school (2000), her family started to treat her in a hospital for fear of affecting her college entrance examination. At that time, Xiaohong’s liver function was normal, after half a year of ordinary interferon had no effect, so she switched to lamivudine, half a year later, Xiaohong’s hepatitis B virus DNA load (concentration) in the blood dropped from 108 copies / ml to 103 copies / ml, but the E antigen did not turn negative. After 14 months of taking the drug, the DNA rebounded to 106 copies/mL. For this reason, her family found Dr. Chen Xinyue from Beijing You’an Hospital affiliated with Capital Medical University to treat her, and Xiaohong was tested positive for YMDD mutation, which means that the hepatitis B virus in her body had become resistant to lamivudine. At that time, there were still a few months before the college entrance examination, in order to control the disease, Chen Xinyue suggested that Xiaohong continue to take lamivudine until the end of the college entrance examination and stop the drug for observation, and to seek for suitable treatment opportunities. In 2002, Xiaohong was admitted to an overseas university and her liver function was checked every 3 months. One and a half years later, there was an elevation of transaminases (299 U/L), and Chen Xinyue thought that the time for antiviral treatment had finally come. Considering that Xiaohong had been treated with regular interferon and lamivudine, both of which were ineffective, Chen Xinyue suggested that she switch to a combination therapy of long-acting interferon plus lamivudine. Interferon needs to be refrigerated, so Xiaohong spends 50 yuan a month to rent a refrigerator in a cold drink store in front of her school, where she goes every week to give herself a shot of long-acting interferon. At first, the dose was 180 micrograms per shot, and Xiaohong developed a more severe interferon intolerance, with muscle aches and lethargy throughout the day. Considering Xiaohong’s light weight, Chen Crescent decided to lower the dose to 135 micrograms, and the situation improved, but there were still mild side effects. This time Xiaohong insisted on the treatment for 15 months, and the E antigen finally turned negative, and E antibody appeared, i.e. from hepatitis B “big triple Yang” to “small triple Yang”. During the six months of consolidation treatment, Chen Xinyue observed that Xiaohong’s Hepatitis B surface antigen titer (concentration) also decreased significantly, which is a signal that Xiaohong’s immune system responds well and there is a possibility that the surface antigen may turn negative if she continues the treatment. In order to permanently remove the hat of Hepatitis B, Xiaohong and her family agreed to Professor Chen’s treatment program, and finally, after 2.5 years of treatment and spending nearly 200,000 RMB, the surface antigen of Hepatitis B has turned negative, and protective surface antibodies have appeared, which is commonly referred to as “clinical cure” for Hepatitis B. So far, Crescent Chen has already provided treatment for Hepatitis B patients, and the treatment has been completed. Up to now, Chen Xinyue has been following up Xiaohong for more than 2 years, the hepatitis B virus DNA and hepatitis B surface antigen in Xiaohong’s blood are undetectable, the hepatitis B surface antibody in her blood still maintains the positive level, and the pathological examination of liver puncture is also normal, so Xiaohong can live like a healthy person. Xiao Hong’s story is not accidental. At the annual meeting of American Association for the Study of Liver Diseases (AASLD) held in San Francisco in early November this year, doctors from all over the world reported many successful cases. Experts at home and abroad, including Dr. Chen Crescent, agreed that for chronic hepatitis B patients who meet certain conditions, as long as they are treated properly, a clinical cure is no longer a distant dream. Let’s take Xiaohong as an example to see what this new treatment concept is all about.