The cure types of chronic hepatitis B (chronic hepatitis B) mainly include complete cure (virological cure) and clinical cure (functional cure or immunological cure).
What is a complete cure?
Complete cure refers to the absence of serum HBsAg detection, clearance of intrahepatic and serum HBVDNA (including intrahepatic cccDNA and integrated HBVDNA), sustained positive serum anti HBc, with or without the presence of anti HBs. Due to the continuous stable existence of cccDNA and the current lack of specific targeted drugs for cccDNA, complete cure is difficult to achieve.
What is clinical cure?
After completing a limited course of treatment, serum HBsAg and HBVDNA remain undetectable, HBeAg becomes negative with or without HBsAg seroconversion, residual cccDNA persists, liver inflammation is relieved and liver tissue pathology improves, and the incidence of end-stage liver disease is significantly reduced. Clinical cure is similar to the state of spontaneous virus clearance after acute HBV infection, which marks the lasting immunological control of chronic hepatitis B, and is the ideal treatment target recommended by the latest domestic and international guidelines for the prevention and treatment of chronic hepatitis B. Therefore, for suitable advantageous populations, early clinical cure should be pursued as much as possible. Different from complete cure, clinical cure can be achieved by optimizing the treatment scheme in the population with dominant chronic hepatitis B. It can be seen that the clinical cure of hepatitis B can be popularly understood as long-term drug withdrawal, and hepatitis B patients cannot be detected by various detection methods.
How to treat hepatitis B?
At present, there are only two categories of guidelines at home and abroad: oral antiviral drugs and interferons; There are also various personalized treatment options for treatment, such as using oral antiviral drugs alone, interferon alone, oral medication combined with interferon, and so on; Regular treatment and monitoring should be carried out under the guidance of a professional liver disease doctor. The treatment of hepatitis B can be divided into immunomodulation therapy and direct antiviral therapy. The recognized effective drugs both domestically and internationally are mainly interferons and nucleoside analogues.
1. Interferons
Common interferons, pegylated interferons, etc. The treatment course is relatively fixed, the efficacy is relatively long-lasting, the HBeAg seroconversion rate is high, and there are fewer drug resistance variants. The disadvantage is that it requires injection administration and has significant adverse reactions, which is not suitable for patients with decompensated liver function. Long acting interferon can be used, or a combination of long-acting interferon and oral antiviral drugs can be used. The clinical cure rate of long-acting interferon can reach 33%. The initial treatment HBsAg quantification is ≤ 178IU/mL, and the cure rate can reach 62.1%. The treatment course is generally 48 weeks, once a week, with subcutaneous injection of drugs. The course of treatment can be shortened or extended according to the condition. The efficacy can be evaluated at 12 and 24 weeks to determine whether to continue interferon treatment. Interferon should be used with caution or contraindicated in the following population: (1) Pregnant or with short-term pregnancy plans.
(2) History of mental illness (with a history of schizophrenia or severe depression, etc.).
(3) Uncontrolled epilepsy.
(4) Decompensated cirrhosis.
(5) Uncontrolled autoimmune diseases.
(6) Serious infection.
(7) Retinal diseases.
(8) Heart failure.
(9) Chronic obstructive pulmonary disease and other underlying diseases.
(10) Thyroid disease.
(11) Past depression history, uncontrolled diabetes, hypertension, heart disease, etc.
Although interferon is good, there may be some side effects such as flu like symptoms, fever, headache, muscle pain, and fatigue; Decreased white blood cells and platelets (recoverable upon discontinuation of medication); Mental abnormalities, anxiety or depression; Autoimmune diseases, etc., but except for common flu like symptoms, leukopenia, and thrombocytopenia, the incidence of other diseases is low.
2. Nucleoside (acid) analogues such as entecavir, tenofovir disoproxil fumarate, propafenone fumarate, lamivudine, adefovir disoproxil, telbivudine, etc. Oral administration can cause mild adverse reactions in patients, and can also be taken by patients with decompensated liver function. The disadvantage is that the treatment course is relatively unstable, the efficacy is not long-lasting, the HBeAg seroconversion rate is low, and if taken for a long time, it may also develop drug resistance. After stopping the medication, the condition may worsen. Clinically, most patients with hepatitis B need to take antiviral drugs for a long time and in a standardized manner. The following matters should be noted:
(1) Regular examination is a must for every hepatitis B patient, which can judge the treatment effect and detect whether the virus is resistant to drugs.
(2) Persisting in taking medication is of utmost importance. Do not believe in so-called secret formulas and folk remedies. Instead, adhere to the formal treatment plan of a reputable hospital to avoid the recurrence or rebound of the condition.
(3) Life management should be done well, with regular diet, sufficient sleep, regular physical exercise, emphasis on balancing work and rest, and maintaining a good mood, all of which have great benefits for improving the condition.
Nowadays, hepatitis B is no longer a terrible disease, and can be cured clinically through standardized treatment; We should correctly understand hepatitis B, reject hepatitis B discrimination, and encourage carriers and patients to actively receive treatment.
What are the dominant groups for clinical cure of hepatitis B
1. Chronic hepatitis B is clinically diagnosed;
2. Age range of 18-60 years old;
3. Patients who have been receiving NAs treatment for more than 1 year and meet the following conditions:
HBsAg ≤ 1500IU/ml
HBeAg negative
serum HBVDNA quantification<100IU/ml or below the hospital detection limit
4. No contraindications for interferon treatment.