By Shuquan Cheng
Chief Physician, Department of Hepatology, Third People’s Hospital of Guilin
Since the introduction of the first oral nucleos(t)ide analogs (NAs) lamivudine for the treatment of chronic hepatitis B (CHB) in China in 1998, there has been a continuous effort over 25 years to explore various generations of drugs by medical, pharmaceutical, and technological researchers. The NA family has expanded to include entecavir, telbivudine, tenofovir disoproxil fumarate, tenofovir alafenamide, besifovir and so on. In particular, the latter four have become the mainstay for controlling hepatitis B virus (HBV). Additionally, long-acting interferons, when used in combination or sequentially with NAs, enhance the treatment's effectiveness, providing hope for reaching new heights in the cure of HBV.While significant progress has been made in controlling HBV infection and achieving positive treatment outcomes for CHB patients, the vastness of China, regional differences in healthcare conditions, and diverse lifestyles pose challenges in screening and treating CHB, as well as related liver cirrhosis and liver cancer patients. To cross the goal set by the World Health Organization to eliminate viral hepatitis by 2030 requires sustained efforts.
With the release of China’s updated “Guidelines for the Prevention and Treatment of Chronic Hepatitis B” and “Expert Consensus on Expanding the Antiviral Treatment Strategy for Chronic Hepatitis B” in 2022, along with successful implementation and positive outcomes of projects like the “Everest” for adult HBV cure, the “Sprout” for pediatric HBV cure, and the “Oasis” for HBV-related liver cancer, controlling and curing hepatitis B have become common goals and urgent needs for many CHB patients.
To effectively control and potentially cure hepatitis B, a crucial step is a detailed assessment to understand the full extent of the condition.
1. Initial Awareness and Calm Approach
When individuals receive their medical examination reports for the first time, the array of markers and values may cause anxiety, especially when abnormalities in liver function or the HBV-related markers are identified. It’s essential to stay calm and avoid immediate self-diagnosis or hasty requests for medication. Standard medical examinations provide a preliminary understanding of one’s current health status but are insufficient for a definitive diagnosis, especially for chronic conditions like hepatitis B. Further specialized examinations and consultations with healthcare professionals are necessary before making treatment decisions.
2. Tailored Approaches for Different Situations
HBV infections vary based on age, gender, and viral genotype. Beyond the initial detection of HBV infection, it is essential to explore factors such as HBV DNA levels, quantitative HBsAg data, liver fibrosis, and stiffness assessments, as well as complete blood counts. Special consideration should be given to individuals with additional complications, such as HBV-related kidney issues or liver-kidney syndromes, requiring pre-assessment of kidney function, especially in older individuals. Various factors, including occupation, underlying health conditions, and specific patient demographics (children, reproductive-age women, seniors), must be taken into account for personalized treatment plans.
3. Communication and Education to Alleviate Concerns
After obtaining comprehensive information, it is crucial to inform patients about available treatment options, potential treatment durations, expected therapeutic outcomes, precautions, and safety considerations. Patients may have misconceptions or doubts about the necessity of extensive examinations, so clear communication and understanding are key to alleviating concerns. Providing patients with relevant medical knowledge empowers them to make informed decisions and reduces anxiety during the extended treatment process. Addressing potential side effects of medications, especially for long-acting interferons, should be discussed, emphasizing the frequency, severity, timing, and appropriate responses to adverse reactions.
In summary, the journey from detecting HBV infection to long-term treatment and achieving effective control leading to cure is a complex and intricate process. The initial steps, as highlighted in this article, play a crucial role in preparing patients for the challenges ahead. By understanding the importance of detailed assessment, tailoring approaches based on individual circumstances, and fostering effective communication, patients can navigate their treatment journey more smoothly, ultimately achieving successful outcomes.
