Does HBV need antiviral treatment?

According to statistics, China’s current hepatitis B virus infection rate is about 60%, which is equivalent to more than half of people suffering from different degrees of hepatitis B virus infection. Some people may question this data, because in reality there are not so many patients with hepatitis B! For this problem, we have to distinguish between two concepts: hepatitis B virus infection and chronic hepatitis B virus.

Follow hepatitis B
Not everyone will get sick after being infected with hepatitis B virus, because the body has immune system protection. If the immune system is stronger than the virus, the virus can be removed; if the two are evenly matched, they are in a coexisting state, called virus carrying; if the virus is stronger than the immune system, the virus will damage and damage the liver, forming acute or chronic hepatitis, hepatitis lasts Healing will form liver cirrhosis or liver cancer! So as long as you have been infected with hepatitis B virus, whether you are cured or a carrier or hepatitis, you are all infected with hepatitis B virus. Chronic hepatitis B refers to patients with hepatitis B after hepatitis B infection, so the number of the latter is much smaller than the former.

Hepatitis B evolves naturally
There is a fact that everyone should understand that the current level of medical technology is not yet able to eliminate the hepatitis B virus. The current treatment of hepatitis B is to control hepatitis B and prevent the development of hepatitis to cirrhosis, and the main treatment is antiviral therapy. Many people often ask, I found out that it is Xiao Sanyang or Da Sanyang. Do I need antiviral treatment? In fact, Xiao San Yang or Da San Yang only responds to an infection state. The difference is that the big San Yang virus is relatively strong in replication and highly contagious. Anti-viral treatment is not required, and the following two conditions must be met at the same time:

(1) HBV DNA level: HBeAg positive patients, HBV DNA ≥20 000 IU / mL (equivalent to 10 copies of the 5th power / ml); HBeAg negative patients, HBV DNA ≥2000 IU / mL (equivalent to 10 times of 4 Square copy / ml)

(2) ALT level: ALT is generally required to continue to rise ≥ 2 times the upper limit of normal (more than 3 months); if treated with interferon, in general, ALT should be ≤ 10 times the upper limit of normal, and total serum bilirubin should be <2 times Normal upper limit

Two and a half
Some people will also encounter a problem, HBV DNA copy number is very high, up to 10 to the 7th power or even higher, but the transaminase is not more than 2 times, should antiviral treatment be required in this case?

Generally speaking, if the patient has HBV DNA> 20,000 IU / mL and ALT <2 times the upper limit of normal value (female <50 U / L, male <70 U / L), HBeAg-positive persons, especially those who are> 40 years old and young Those with HBV infection (ie, long infection time) should undergo liver biopsy to assess the severity of liver histological lesions

Liver biopsy
Liver biopsy is the only method to simultaneously assess liver fibrosis and liver inflammation. If the biopsy specimen indicates moderate or severe inflammation (A2 or A3) or significant liver fibrosis (≥F2), treatment is recommended.

Alternative methods for assessing fibrosis include elastography (a liver color Doppler ultrasound examination) and liver fibrosis biomarkers (eg FIB-4 / FibroTest). If these non-invasive tests suggest significant liver fibrosis (≥F2), treatment is recommended.

Follow hepatitis B
Under special circumstances, antiviral therapy should be used even if the liver function is normal

  1. It has been confirmed that the liver cirrhosis is caused by hepatitis B virus infection, even if the liver function is normal, it is necessary to resist the virus!
  2. The population of people with low immunity mainly includes some patients who need to take immunosuppressants for a long time, as well as tumor (or postoperative) patients who need to receive chemotherapy.

How is your liver
to sum up

The two-half halves of hepatitis B mainly indicate the status of viral infection and the strength of infectivity. Whether antiviral therapy is needed depends on liver function and virus replication level, and sometimes liver biopsy is required to assess liver inflammation and fibrosis!

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