Antiviral therapy is the key to the treatment of chronic hepatitis B. However, antiviral therapy is a long-term process. Many patients do not have sufficient psychological preparation for long-term treatment, so treatment is often interrupted, resulting in treatment failure.
For this reason, Dr. Clove summed up the four misunderstandings that hepatitis B patients should know in antiviral treatment, corrected some misunderstandings, and hoped that patients would increase their confidence and patience in antiviral treatment, achieve the success of treatment as soon as possible, and recover their health.
Myth 1: Virus Inhibition ≠ Virus Removal
The primary goal of hepatitis B antiviral drugs is to inhibit the replication of the virus. Nucleoside (acid) drugs can [pretend] to be nucleosides needed for virus replication. Pseudonucleosides replace true nucleosides and drill into the virus DNA strand [wrap up], resulting in the virus DNA strand cannot continue to extend and virus replication is inhibited.
Therefore, shortly after hepatitis B patients take nucleoside (acid) drugs orally, HBV DNA in blood will decrease and liver function will return to normal.
Patients are often very happy to see this result. Some patients mistakenly believe that the virus has been removed and the disease has been cured. So stop taking the medicine, or miss taking it, and reduce the dosage of the medicine.
In fact, after hepatitis B virus invades hepatocytes, it will quickly [take root] in the nucleus of hepatocytes.
The [root] of the virus is still there and the [heart] is not dead. The drug only temporarily inhibits it. Once the drug is stopped or the drug dose is reduced, the [root] of the virus will [germinate] again and replicate a new virus.
Therefore, virus inhibition ≠ virus clearance.
Patients treated with nucleoside (acid) drugs must have psychological preparation for long-term treatment and be patient, which is the key to victory.
Myth 2: Virus Resistance ≠ White Treatment
The current nucleoside (acid) antiviral drugs cannot eliminate the virus, but can only achieve the purpose of inhibiting virus replication, so long-term treatment is needed.
However, long-term treatment (especially the selection of drug-resistant drugs such as lamivudine and telbivudine) often leads to virus mutation and drug resistance, which is manifested by the rebound of HBV DNA quantity and even the recurrence of liver function abnormalities.
Patients who encounter drug resistance are often very depressed: [After so many years of treatment, they have been treated for nothing! ]
In fact, it is not necessary. Why do you say that?
You know, hepatitis B virus infection is more prone to liver cirrhosis and liver cancer.
Judging from the development law of chronic hepatitis B, if not treated, repeated inflammation and necrosis will bring direct harm:
- Liver fibrosis liver function decompensation
It will also bring indirect harm: gene mutation may occur due to excessive proliferation of hepatocytes, leading to liver cancer.
Therefore, although some patients developed drug resistance during treatment, virus drug resistance ≠ treatment was in vain: the previous treatment delayed the progress of liver diseases and won time for prolonging life and waiting for updated drugs to come on the market.
After drug resistance, patients may still recover if they switch to other effective drugs.
Please remember that only by building up confidence can we overcome hepatitis B.
The third misconception: Can’t stop taking drugs ≠ drug addiction
Although virus replication can be inhibited quickly after receiving nucleoside (acid) antiviral drugs, virus replication can occur again after drug withdrawal, and with the increase of transaminase (such as ALT), some patients may even suffer from serious liver diseases.
This condition is called “rebound after withdrawal” by doctors.
This is because antiviral therapy only plays a role in inhibiting the virus, and hepatitis B virus has not been completely removed, so the drug cannot be stopped.
Some patients mistakenly believe that this [rebound] after drug withdrawal is an antiviral drug [addiction]. Like drug abuse, it cannot be interrupted from now on, so they dare not use antiviral drugs for treatment.
However, drug addiction is different from drug therapy that cannot be stopped.
Drug dependence or addiction will not only cause toxic damage to various organs of the drug user’s body, but also cause great psychological and mental damage. However, there are four differences between antiviral treatment and drug addiction for hepatitis B patients:
During the withdrawal period, the patient will not have withdrawal symptoms only found in drug addiction.
Before and after drug withdrawal, there is a definite dose for drug use, and the dose will not be changed at will.
The disease worsened again after drug withdrawal, not because the body was dependent on drugs, but because hepatitis B virus was not completely removed.
The purpose of taking medicine after withdrawal is to inhibit the newly replicated hepatitis virus during withdrawal, not to control certain symptoms of mental dependence.
Therefore, drugs cannot be stopped ≠ drug addiction. Once the disease is cured or the drug withdrawal standard is reached, drugs can be stopped.
The fourth misconception: long-term medication ≠ lifelong treatment
Some patients are afraid of long-term treatment. They say, “Can I stop taking medicine?” Do you have to take medicine for life? ]
Some patients have become bored after taking medicine for a long time: [Take medicine every day, what is the head! ]
Antiviral therapy for hepatitis B is long-term and is divided into short-term goals and long-term goals:
- Short-term goal: Effective inhibition of HBV replication Long-term goal: disappearance of HBsAg
Only when the long-term goal is achieved can the drug be stopped.
However, there are conditions for the realization of long-term goals.
One is to treat it early. The realization of long-term goals is related to the degree of liver fibrosis. If liver cirrhosis has developed, it requires lifelong medication.
The second is to stick to it. The realization of the long-term goal depends on persistent and long-term inhibition of the virus. If treatment stops and treatment is often interrupted, not only will the drug resistance of the virus be caused, but also the end point of treatment will never be reached.
Therefore, long-term treatment ≠ lifelong treatment.
However, the end point cannot be reached quickly. Long-term and effective antiviral treatment is required, and it often takes several or more years of efforts to reach it.
Responsible Editor: Jing Liu