Recently, many hepatitis B friends sent me private messages, why have you still been unable to transfer Xiao Sanyang after taking medicine for many years? They have always used medicine in a standardized manner. Is there any better way? Will there be many , big sanyang in the future, and will there be no chance to turn into small sanyang? Today I will share a letter from a netizen.
Netizen consultation: Dr. Huang, hello, I am a hepatitis B patient for many years. I have been a child since I was a child and have a family history. I have taken entecavir for 12 years. This hospital follow-up and re-examination was negative. The liver bullet showed a cirrhosis of 4.7kPa, B ultrasound mild fatty liver , there was a 19*19 cyst, the parenchymal echo slightly thickened, and the two pairs and half showed a large three-positive positive surface antigen 874.9, and the liver and kidney dysfunction, and glucose are all normal. The doctor recommends 1: Continue to take entecavir; 2: Inject interferon for one year. I want to hear your suggestions, thank you.
Reply: There are many people like this netizen who have been antiviral for many years and have been a big three-yang. Even the surface antigen level is very low, and it is difficult for e-antigen to change. If you encounter such a problem, you need to know two points:
1. To better control hepatitis B, in addition to maintaining DNA negative, you must also achieve the conversion of e antigen.
2. Currently, many patients who cannot convert e antigens in clinical practice may have other reasons: for example, the hypersensitive DNA is not negative; the e antigen is not stuck, but is constantly declining, but is just because its own immune activation is not sufficient and the decline is slow. If this type of patients can achieve DNA negative by adjusting the treatment plan and continue to monitor the changes in e antigen, a considerable number of patients can still turn into Xiaosanyang.
This netizen has used entecavir to fight virus for 12 years, but the e antigen is still positive. Should we continue to use entecavir or combined with interferon?
First, it is necessary to confirm whether the DNA of the hepatitis B virus turns negative. If the high-sensitivity reagent can detect signals, it is not recommended to continue using entecavir alone. It is recommended to adjust the plan in time to achieve DNA negative as soon as possible, which can reduce the inhibition of the virus on liver immune function and indirectly increase the possibility of e-antigen conversion.
Another thing to note is that after a few patients have antivirals, their surface antigens, DNA and e antigens respond better in the early stage, but the e antigen does not decrease in the later stage, and even rebounds. It is possible that the hepatitis B virus DNA has not reached the level that it cannot be detected continuously. In other words, the hypersensitive DNA has mild recurrence, sometimes negative, and sometimes positive. This situation may also affect the conversion of e antigen. If we discover this phenomenon and adjust the drug regimen in time, we can achieve a continuous undetectable (TND) state, some patients can also successfully achieve e-antigen conversion.
If the DNA of this netizen has been negative for many years, it is necessary to evaluate the changes in the level of e antigen in recent times. If the e antigen is still declining, you can continue to monitor it. Generally speaking, if the surface antigen and (or)e antigen are gradually declining, follow-up can be continued in the short term, and there is no need to rush to adjust the plan.
Secondly, there is currently no treatment plan to significantly increase e-antigen conversion, and there are still many patients who choose NA and interferon, and the conversion of e-antigen cannot be achieved.
So, before this netizen decided to continue using entecavir alone or combined with interferon, he might as well confirm the true status of the DNA and see how the changes in the e antigen in recent times. If he really plans to use interferon, he will monitor the e antigen later. However, whether the treatment will take 1 year depends on the response of the e antigen after combined treatment. If interferon is not used without conditions, ensure that the DNA is continuously negative for a certain period of time and the liver function is normal.
