LuckCong's Health Blog

The vast majority of patients with resistance to its own circumstances, such as Mangranbuzhi not adjust treatment will eventually lead to worse Chinese hepatitis B is a big country, a total of 120,000,000 people living with hepatitis B, in which Guangdong is the "hardest hit." According to the latest version of the "guidelines for prevention and treatment of hepatitis B", in order to achieve the goal of the treatment of hepatitis B, hepatitis B patients must adhere to the long-term anti-viral treatment. However, the Guangdong Provincial Institute of Infectious Diseases director, hospital infection in the South of internal medicine Professor Hou Jinlin pointed out that the anti-viral treatment, although the effect was recognized by the medical profession, but after taking the virus mutation and drug resistance has become a clinical problem can not be avoided. According to estimates, since the anti-viral drugs in China has been used in clinical, it is estimated that 100 million patients have used or are in use antiviral treatment, which has an estimated 100,000 drug resistance of hepatitis B patients, and The vast majority of their situation Mangranbuzhi ultimately delaying treatment led to the deterioration of the condition. Antiviral drugs Yizhi virus mutation Hou Jinlin, recognized at home and abroad and effective anti-viral drugs, including the main types of interferon and nucleoside (acid) analogue two broad categories. Oral nucleoside (acid) analogues can inhibit virus replication, in the short term can play a significant effect, but its drawback is the need to maintain long-term treatment, such as "Da Sanyang" Patients want to eat at least two years or more, "Xiaosan Yang" is a longer course of treatment of patients, continue to have poor efficacy of drugs. In addition, the use of nucleoside antiviral drug therapy is likely to occur, the disease is easy to stop after a rebound. It is learned that in clinical practice the most widely used nucleoside analogues lamivudine is, statistics show that patients taking the drug a year after the virus mutation rate of 14%, 38% for the second year, third year 49% , The fourth year of up to 66%. The new out of adefovir dipivoxil treatment before the 3-year low although the rate of drug resistance, "Xiao Sanyang" to the treatment of patients with Article 5, the virus mutation rate may reach 29%. In addition, was recently approved for clinical telbivudine, although more than lamivudine suppression of the virus and improve the ability of e antigen seroconversion dual role, but after the second year in the use of virus mutation rate is not Low. It is due to the existence of these problems in the long course of treatment, patients and doctors must have felt at the end, attach great importance to the resistance, the use of antiviral drugs to a patient's full understanding of this important information. B preferred to deal with anti-retroviral therapy In order to prevent hepatitis B virus outbreak in the human body, is the most effective way to carry out anti-viral treatment. In the just-concluded Asia-Pacific Association for Study of Liver Diseases 17th Annual Conference of the thousands of international disease experts called on the United States the use of association for the study of liver disease in 2007 released the latest version of "hepatitis B prevention and treatment guidelines." The guide is of the view that patients with hepatitis B should adhere to long-term anti-viral treatment. Although anti-retroviral therapy has been recognized by the medical profession, however, pointed out that Hou Jinlin, early single type of anti-viral drugs, in the event of resistance and response to virus mutation, it can not substitute for the use of drugs in the treatment of hepatitis B This is the most prominent issues . Worst of all, not only this Mangranbuzhi patients, many doctors are not aware of the problem. According to estimates, China is at least 100,000 of the emergence of drug resistance in patients. Despite the anti-viral drugs continues to introduce new patients with drug resistance, the use of alternative drugs or more of the drug has become a reality, the need to attach great importance to the specialist, do not miss the treatment of patients with the "turning point" and lead to further deterioration. In the treatment of drug resistance can be prevented Although the issue of hepatitis B in clinical resistance to the doctor brought a lot of problems, but fortunately, the types of antiviral drugs is increasing. It is reported that as early as the only antiviral drug lamivudine, but now the "family of antiviral drugs" has been "growing", 6 kinds of drugs have been approved by China for the treatment of anti-hepatitis B virus. According to the present level of anti-viral treatment, if patients with drug resistance, fully replacing the drug or drugs, the treatment of joint. Hou Jinlin said that the choice of future anti-viral treatment for hepatitis B, the drug may have some mixed use, could play a "cocktail" therapy, can effectively reduce the resistance, but also enhance the effect. Optimization of treatment can not keep up The number of antiviral drugs, this is a good thing, but now there is an additional problem: In the past few drugs, compared with single treatment, the drug is more, treatment should relevant diversification, as a result of both diagnosis and treatment of people, As a result of diagnosis and treatment when they should be. What is the time to start anti-retroviral therapy? How to determine whether the emergence of drug resistance in patients with HIV and mutation? Emergence of resistant virus and how to deal with variation? When treatment can come to an end? This requires a doctor to determine the appropriate and processing, which currently do not have a unified specification. Anti-retroviral therapy is the most crucial part, Hou Jinlin be summed up as a starting point to find a treatment, the inflection point and end point. Only by grasping the treatment of hepatitis B three points in order to achieve the treatment of the "four transformations" - to maximize the efficacy and minimize resistance, cost-effective and individualized treatment. The so-called "starting point", is a doctor to decide when to start anti-retroviral therapy, the treatment is not a problem, in accordance with the norms, as long as the virus and the level of aminotransferase index reached a certain target, they should start antiviral therapy. Hou Jinlin, said the most troublesome patients to determine whether there is a turning point of the treatment. What is meant by "turning point", he played a vivid metaphor: the Yangtze River in the south have been the source of torrents, if there is no "turning point" will flow to South Asia, but fortunately in the territory of Yunnan Province, the Yangtze River to the east and break, making only in the Yangtze River Now the lower reaches has become a fertile land of fish and rice. To receive anti-retroviral therapy for patients, if treated early in the resistance will be able to find the clues, and in the scramble in front of a timely replacement therapy and drug treatment programs, do not give the virus the opportunity to make a comeback, and this is the treatment of captured " Turning point. " And found that attention to the "turning point", will embark on the rehabilitation of the road condition, to the neglect of the "turning point", it is likely On the contrary, will eventually become irreparable consequences. Doctors found that "turning point", its significance as a farmer sowing seed in the spring, summer harvest will be able to forecast and decide whether to replant some crops. However, Hou Jinlin regret that, despite the "turning point" is so important, but in the actual treatment, liver disease, many non-professional doctors did not realize that this did not advise patients on a regular basis to carry out quantitative virus, drug resistance and liver function tests Lead to the treatment of patients with missed opportunities in vain. Medication can decide on the next six months treatment How to find the treatment of the "turning point"? Hou Jinlin said that the medical profession has proposed a "road map hepatitis B treatment," the concept is meant to give patients anti-retroviral therapy six months (24 weeks), the virus DNA as a decision-making level, to predict the treatment of one year and two years at the time of Effect. If the treatment six months when the lower the viral load, and a year for two years when the better effect, the emergence of drug resistance are less likely; six months if the therapy when viral load can not be reduced to a low level, said the existing treatment Program is not satisfactory, you can consider adjusting the treatment strategy. Young people preferred initial treatment immune anti-retroviral therapy For some young patients with newly diagnosed, such as children, young people in particular to prepare children, as well as the use of nucleoside (acid) analogue-resistant patients, but also considering Immune regulation of interferon-type anti-viral drug treatment. Hou Jinlin, some young patients when infected with hepatitis B virus, due to the virus in the body longer, so that the immune cells it resulted in paralysis, is the misconception that the body's normal cells, the bad guys do not take a pro-active " Brought to justice. " Immune-based anti-virus treatment is the body in the reconstruction of the internal confrontation of the hepatitis B virus defense mechanisms, first of all, "wake up" immune cells, it keep their eyes open and identify the disorder in the body for hepatitis B virus, and then further to eradicate these invasive , To protect the body's normal operation. The human immunodeficiency virus, hepatitis B and the "battle" consists of two phases: First, the eradication of the virus in the blood, in order to clear the period of serum; Second, the eradication of the Organization of the virus, the hepatitis B virus replication Zhi Dao "Lao Chao", which is Removal of immunity period. Young people are in the immune clearance phase, based on the use of immune clearance of interferon-type anti-viral treatment than other age groups of patients better. Need to be reminded that the use of some types of interferon patients did not take an early response to emerging or effect on the drug on its own. Hou Jinlin reminded that this was not recommended for the treatment of some types of interferon response of patients a few months after the emergence of e antigen negative, followed by the withdrawal of about 10% of patients follow-up effects, not only will affect the free drug efficacy Will ultimately affect their treatment process.