Hepatitis B Antiviral Therapy: Essential Guidance for Patients

The recent surge in online inquiries might be linked to the ongoing pandemic, as more patients are turning to digital platforms for medical advice. Over the past few days, I've noticed an increase in consultations regarding antiviral treatment for hepatitis B. Some patients, although receiving initial care at hospitals, often fail to maintain consistent follow-ups. As time passes, important medical advice tends to be forgotten. In light of this, I'd like to provide a concise overview based on the latest clinical guidelines to help clarify treatment decisions.

Understanding the Basics of Antiviral Treatment
As a hepatobiliary surgeon specializing in malignant liver diseases, I frequently encounter patients seeking advice on antiviral therapy. Before the release of the 2019 Hepatitis B Treatment Guidelines, most antiviral prescriptions were handled by internal medicine doctors. They typically considered several factors: whether HBsAg was positive, if HBV-DNA levels exceeded 10^5 copies/mL, whether liver enzymes were more than twice the normal range, and if the patient was over 30 years old. However, different doctors sometimes gave conflicting recommendations, leaving patients confused about whether to start treatment.

Key Changes in the 2019 Guidelines
The 2019 guidelines simplified the decision-making process. Here are the most important updates:
1. If a patient tests positive for HBV-DNA (above reference levels) and has abnormal liver enzymes, antiviral therapy is strongly recommended.
2. For patients with normal liver function but a family history of cirrhosis or liver cancer, being over 30 years old and HBV-DNA positive warrants proactive antiviral treatment.
3. All patients diagnosed with HBV-related hepatocellular carcinoma or other biliary tract malignancies should receive antiviral therapy if HBsAg is positive.

Consistent Monitoring Is Crucial
During treatment, regular follow-ups are essential. Liver and kidney function tests, along with HBV-DNA levels, should be monitored closely. Based on these results, some patients may need to switch medications to achieve better viral suppression and reduce the risk of drug resistance.

With more time spent at home due to recent local outbreaks in Shanghai, I hope this information can offer clarity and support to those managing hepatitis B. Let's all stay safe and healthy during these uncertain times. My best wishes go out to every reader for peace, wellness, and happiness.