How to treat chronic hepatitis B?

Editor’s Note:

Recently, the State Health Planning Commission publicized the price reduction of an antiviral drug for the treatment of chronic hepatitis B, and it is also possible to enter medical insurance. Because China is a big country with chronic hepatitis B, the news has been well received by doctors and patients.

Both the government and the pharmaceutical factory are so forceful that we don’t need to know how to treat chronic hepatitis B as soon as possible.

Does chronic hepatitis B need to be treated?

Not all patients with chronic hepatitis B need to receive drug therapy, the most important thing is to look at an index called glutamic pyruvic transaminase (ALT) in the liver function test sheet. If ALT rises and blood tests show that hepatitis B virus replication is very active, that is, HBV DNA ≥ 2000 IU/ml (104 copies/ml), whether it is a big three positive or small three positive patients, antiviral therapy should be used in theory.

Of course, you don’t need to judge for yourself, draw blood for hepatitis B antibody titer and liver function examination, and then see a doctor.

If it is to be treated, how should it be treated?

Because the direct cause of chronic hepatitis B is infection with chronic hepatitis B virus, the most important thing is antiviral treatment.

The existing treatment methods mainly include interferon that needs injection and nucleoside (acid) analog tablets. The two methods have their own advantages and disadvantages, and doctors will suggest them according to the different conditions of each patient.

However, interferon needs injection, after all, it is a little troublesome, and patients with liver decompensation and liver failure cannot use it. Therefore, although the long-term effect of interferon is good, many patients still choose drugs of oral nucleoside (acid) analogues.

It’s three points of poison, not to mention my liver is not good!

Patients with chronic hepatitis often face the problem of “anti-inflammatory and liver protection”. At the same time, using many drugs has good therapeutic effect, but it also increases the burden on the liver. So how to balance the advantages and disadvantages brought by the combination of drugs?

If the patient’s liver function is very poor, the doctor will properly select as few anti-inflammatory and liver-protecting drugs as possible on the basis of antiviral treatment, and only one can be used instead of two, thus reducing the burden on the liver as much as possible.

We should know that the more drugs to protect the liver, the better. Therefore, we must truthfully inform the doctor of all the drugs he is taking when seeing a doctor, so as to prevent some doctors from increasing the burden on the liver because they do not know the drugs they are using at the same time.

Then this medicine is so good, can you take more?

1. Eat one more of different drugs: no!

One antiviral drug is enough, and in case it doesn’t work, you can change to another one. Never be smart and use multiple antiviral drugs in combination at the same time.

At the same time, the use of several antiviral drugs will not only not increase the therapeutic effect, but also cause life-threatening serious liver damage and lactic acidosis.

2. Take more of the same drug: no!

This medicine is not without side effects, but the vast majority of side effects brought by taking medicine are much lighter than the damage to the body caused by hepatitis B itself.

The most common side effects are diarrhea, dizziness, pain and weakness. About 10% of patients suffer from these discomfort. Other serious side effects mainly occur in patients who do not listen to their doctors, use several similar drugs in combination, or take drugs for a long time. These serious side effects include lactic acidosis, allergy, and affecting kidney function.

3. Do you want to go to the hospital in case of what?

Therefore, we remind all patients that if the following alarm symptoms occur, they should return to the clinic or see the emergency department in time, change the therapeutic drugs and treat the alarm symptoms symptomatically:

    Severe nausea and vomiting; Upper abdominal pain; Loss of appetite; Extremely weak, tired and dizzy; Tachycardia or palpitations; Dyspnea; Oligouria or dark yellow and dark brown urine; Severe muscle pain, etc.

How long can I stop taking the medicine?

Antiviral drugs such as nucleoside (acid) analogues need to be taken for a long time. The specific timing of withdrawal varies from person to person, and must be strictly in accordance with the doctor’s advice. Generally speaking, the longer the consolidation treatment takes, the less likely hepatitis B recurrence will be after withdrawal.

At present, according to the advice of the World Health Organization (WHO), patients with liver cirrhosis need to take medicine for life and cannot stop taking medicine by themselves. For patients without liver cirrhosis, drug withdrawal may be considered after continuing to consolidate treatment for one year under the following conditions:

(1) HBeAg has reached serological conversion;

(2) HBV DNA could not be detected;

(3) ALT is normal;

However, it still needs to be stressed that withdrawal of drugs requires the doctor’s advice. Unauthorized withdrawal of drugs may lead to more thorny problems such as drug resistance and relapse.

Can I have children after taking antiviral drugs?

If interferon is used for treatment, you need to stop taking the drug for half a year before conception. If you are accidentally pregnant while using interferon, abortion is generally recommended.

However, nucleoside (acid) analogues are relatively safe for pregnant women and can be changed to such drugs during pregnancy.

Of course, the final choice of whether to have a child or not must be made on the basis of full discussion with doctors and weighing the pros and cons.

What should I do if I forget to take the medicine?

The treatment of hepatitis B requires long or even lifelong medication.

If you think of it just after taking the medicine, make it up.

If it is almost time to take the next medicine before remembering that the last medicine has not been taken, then just take the next medicine.

Never take two doses of drugs at once to make up for the drop, which will increase the side effects.


Nucleotide analogues are not a panacea, and not everyone has an effect. If you take them for a long time, hepatitis B antigen (HBeAg) has not turned negative, or the virus replication is still active, you should return to your doctor in time and find a doctor to replace or add drugs with stronger antiviral effects.

Although there is no complete cure for hepatitis B, but the antiviral effect of nucleoside (acid) analogues, such drugs, can already well control the progress of hepatitis B. Under the standard treatment, hepatitis B patients can also enjoy life like normal people.

Reasonable application of antiviral drugs, following the doctor’s advice and avoiding blind drug withdrawal and dressing change can prevent the further progress of hepatitis B and improve the quality of life.