Medical research: A reporter recently learned from the infection department of the Third Affiliated Hospital of Zhongshan University that hepatitis B has been cured clinically, and some patients’ surface antigens can turn negative. Professor Gao Zhiliang, director of the infectious diseases division of the Third Affiliated Hospital of Zhongshan University, said that the Department had followed up the outpatient department to establish a large data bank and a cohort study of hepatitis B patients. Since the launch of the I-cure project in 2015, the clinical cure rate of hepatitis B patients enrolled in this project has reached 1/3.
According to who data, there are about 257 million people infected with hepatitis B virus in the world, and the number of deaths caused by hepatitis B in the world reaches 887000 every year. The most important characteristic of hepatitis B clinical cure is hepatitis B surface antigen turning negative.
According to the guideline for chronic hepatitis B prevention and treatment published in 2015, some suitable patients should pursue the clinical cure of chronic hepatitis B as far as possible, that is, continuous virological response after treatment, surface antigen HBsAg disappearance and ALT (one of liver function indexes) and liver histological changes.
Gao Zhiliang pointed out that although patients treated with nucleoside antiviral drugs such as entecavir or tenofovir for a long time can obtain continuous disease control, about 7% of patients will develop liver cancer within five years. If patients have liver cirrhosis, this proportion is as high as 17%.
If the surface antigen turns negative, the probability of suffering from liver cancer is only 0.8%. Even if the patient has liver cirrhosis, only 6% of the probability will develop liver cancer. Therefore, achieving clinical cure is of great significance to hepatitis B patients.
To achieve the “operational goal” of clinical cure, oral antiviral drugs alone can not “fight alone”. In hepatitis B patients taking oral antiviral drugs, if the surface antigen is below 1500 units, long acting interferon can be added to treat the disease, and 30% of the patients can be removed.
“Chronic hepatitis B” should not pursue “clinical cure”
However, some patients are not suitable for “hepatitis B clinical cure”.
Experts emphasize that patients with chronic hepatitis B positive for e antigen will have a large probability of producing the virus in the liver at this time. If the long-term interferon therapy is used, the probability of clinical cure of hepatitis B is relatively low.
Patients who have achieved “clinical cure” can stop the drug under certain conditions, and the recurrence probability is not high after stopping the drug. If the surface antigen quantification is checked at an interval of one month, and the value of two consecutive times is lower than 0.05, the patient can stop the drug. However, it is recommended to follow up once every six months after drug withdrawal to prevent recurrence.
Gao Chi Liang’s team also found that many patients who received clinical cure of hepatitis B were relatively young. Doctors speculate that young patients have a shorter time to infect hepatitis B virus than their elderly patients, and that their immune function is more perfect. After receiving interferon therapy, their immune function can be mobilized more fully to initiate “attack”, thus giving them more chance to achieve clinical cure.