The fundamental treatment for chronic hepatitis B is antiviral. The currently recommended first-line antiviral drugs include entecavir, tenofovir and peginterferon, and other alternative drugs include telbivudine, adefovir and lambda lamivudine. When evaluating the antiviral efficacy, a hepatitis B virology test is required. The test content includes five hepatitis B indicators and viral deoxyribonucleic acid (HBV DNA).
The test results of five indicators of hepatitis B are often expressed as negative and positive. Under normal circumstances, they should all be negative. Those who have received hepatitis B vaccine or have been infected with hepatitis B virus and have recovered completely may have surface antibody positive, yet those with chronic hepatitis B virus infection appear to be hepatitis b surface antigen and core antibody continue to be positive, and there may be E antigen or E antibody positive at the same time.
HBV DNA lower than the test level is negative, and higher than the test level is positive.
Hepatitis B becomes negative is a general concern of clinicians, patients and their relatives. However, “hepatitis B becomes negative” is a general term. Different test items have different concepts and their clinical significance is not exactly the same.
1. Hepatitis b surface antigen becomes negative
Hepatitis b surface antigen is an important indicator of hepatitis B virus infection and an important evaluation indicator of patients after treatment. Its becoming negative is the ultimate goal of treatment for hepatitis B patients, which means that the virus infection is completely eliminated. Negative hepatitis b surface antigens are usually accompanied by HBV DNA and E antigens becoming negative, and hepatitis B has fully recovered after this. But there are also exceptions. This is the so-called “hiding hepatitis”, that is, the hepatitis b surface antigen is negative, but the HBV DNA in the blood or liver tissue is still positive, and transaminase is often elevated. In recent years, hiding hepatitis has attracted the attention of many scholars.
2. E antigen becomes negative
Clinically, we can divide chronic hepatitis B into two categories, one is E antigen positive chronic hepatitis B, and the other is E antigen negative chronic hepatitis B. The E antigen is an indicator of active virus replication and strong infectivity. For the first type of patients, when the E antigen becomes from positive to negative and the E antibody becomes from negative to positive at the same time. When this happens, it indicates that the condition tends to be stable, the virus replication ability is weakened, and the infectivity is clearly reduced. The probability of treatment with peginterferon is 30%-40%; use nucleoside medicines treatment, this probability is 20%~30%.
3. HBV DNA becomes negative
Test of HBV DNA can directly understand the content of the virus in the body. The higher the HBV DNA, the more active the virus replication. However, it should be noted that the laboratories of various hospitals have set minimum test values for HBV DNA test, that is to say, when HBV DNA is lower than this level, it cannot be detected. Therefore, when the HBV DNA is lower than the test level or the report is negative, it does not mean that there is no virus in the body. It just means that the virus content is very low, so low that the current technical level cannot detect it. It should also be noted that the test of HBV DNA in various hospitals now uses polymerase chain method (PCR). This test technology requires very high, and different experimental conditions have different results. The inspection results should be compared with each other.
In addition, in our daily work, we often encounter patients or relatives holding HBV DNA test results to ask whether the condition is serious or not. In fact, HBV DNA only reflects the replication status and infectivity of the virus in the patient, yet the severity of the disease mainly depends on liver function. No matter how high the HBV DNA level is, as long as the liver function indicators are normal, the condition can be considered as not serious, or even just a virus carrying state; but if the transaminase is high and there is jaundice, then the condition is serious even if the HBV DNA is negative.
4. Special reminder: Don’t blindly pursue a negative change
Don’t blindly pursue negative change. Hepatitis b surface antigen change is the ultimate goal of treatment for patients with chronic hepatitis B. Due to the intractability of hepatitis B virus and the limitations of drug treatment, very few patients can achieve this goal. Although in the past ten years, with the widespread development of antiviral therapy, the phenomenon of hepatitis b surface antigen becoming negative has gradually increased, but it still accounts for a very small number of the huge hepatitis B patients. In view of this, blindly pursuing hepatitis B to become negative is not advisable. The treatment must be scientific and rational, especially not to believe in unrealistic publicity of false medical advertisements, so as not to give yourself with a heavy ideological and economic burden.
