Do you understand the "big triple positive" and "small triple positive" on the physical examination report?

Hepatitis B is an infectious disease. Data show that HBsAg carriers in my country account for 6.1% of the country's population, and about 86 million people are chronic hepatitis B patients, accounting for 1/3 of the world's chronic hepatitis B virus infection patients. Chronic hepatitis B (abbreviated as chronic hepatitis B) refers to patients with positive chronic hepatitis B virus test, a course of more than half a year or unclear onset date and clinical manifestations of chronic hepatitis. Clinical manifestations include fatigue, loss of appetite, nausea, abdominal distension, pain in the liver area and other symptoms. The liver is enlarged, with a medium hardness and mild tenderness. Severe cases may be accompanied by chronic liver disease face, spider nevi, liver palms, splenomegaly, and abnormal or persistent abnormal liver function. According to clinical manifestations, it is divided into mild, moderate and severe. Chronic hepatitis B virus carriers refer to those who are positive for hepatitis B virus test, have no symptoms of chronic hepatitis, have no abnormal serum ALT and AST for more than 3 consecutive follow-ups within 1 year, and have normal liver histology.

How to read the antibody index on the physical examination report? What are the drugs for treating hepatitis B? What should be paid attention to during the antiviral period? How often should the check be conducted? The following will answer your questions.

What are “big triple positive” and “small triple positive”?

The five hepatitis B indicators are the most commonly used indicators for diagnosing hepatitis B virus (HBV) infection. The five hepatitis B indicators include hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B e antigen, hepatitis B e antibody and hepatitis B core antibody.

1. Hepatitis B surface antigen, abbreviated as HBsAg.

Hepatitis B surface antigen is the most important indicator of whether there is hepatitis B virus infection. A healthy person should be negative (-), and a positive (+) indicates infection with the hepatitis B virus.

2. Hepatitis B surface antibody, corresponding to the first item, the English abbreviation is HBsAb.

A negative (-) result for hepatitis B surface antibody indicates that there is no hepatitis B virus antibody in the body, and a positive (+) result indicates that the person has been vaccinated with hepatitis B vaccine and has produced antibodies, or has been infected with hepatitis B but the body has cleared the virus and produced antibodies.

3. Hepatitis B e antigen, abbreviated as HBeAg.

A healthy person should have a negative (-) result, while a positive (+) result indicates that the hepatitis B virus is actively replicating in the body and is highly contagious.

4. Hepatitis B e antibody, corresponding to the third item, the English abbreviation is HBeAb.

Positive (+) means: e antigen turns negative and e antibody appears, indicating that the replication activity of the hepatitis B virus is weakened; or the hepatitis B virus undergoes genetic mutation and cannot produce e antigen, but the replication activity of the hepatitis B virus is actually more active.

5. Hepatitis B core antibody, abbreviated as HBcAb.

Positive (+) indicates current infection with HBV or past infection with HBV.

1, 3, and 5 are positive: This is commonly known as the "big three positives", which means that you are infected with the hepatitis B virus and the virus is actively replicating and is highly contagious, so you need to seek medical treatment as soon as possible.

1, 4, and 5 are positive: This is commonly known as "small three positives", which means that the person is infected with the hepatitis B virus but the viral replication is reduced or genetic mutations occur, and the infectiousness is relatively weak. However, those with genetic mutations are still in serious condition and need to see a doctor as soon as possible for further evaluation.

The meaning of different indicator combinations can be simply understood from the above table, where "Big Three Yangs" refers to the first row of the above table, and "Small Three Yangs" refers to the second row of the above table.

It should be noted that "big triple positive" and "small triple positive" are not the standards for diagnosing the severity of the disease. Various serum biochemical indicators are the standards for judging the severity of the disease and deciding how to use medication.

What are the drugs for treating hepatitis B?

Drugs for treating hepatitis B are divided into two categories: interferon and nucleoside (acid) analogs.

1. Nucleoside (acid) analogs include: lamivudine, adefovir dipivoxil, telbivudine, entecavir, tenofovir disoproxil, clavudine, etc. The advantages of this type of drug are: "effectiveness, ease of use, and safety", but they also have disadvantages such as irregular treatment courses, easy occurrence of viral resistance, and easy recurrence after drug withdrawal. Therefore, the new guidelines emphasize the selection of potent and low-resistance antiviral drugs, such as entecavir (ETV) and tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide fumarate tablets (TAF), and no longer recommend the original lamivudine, adefovir dipivoxil and other drugs. For patients who are currently taking non-preferred drugs, it is recommended to switch to potent and low-resistance drugs to further reduce the risk of drug resistance [1].

2. Interferon-α treatment. my country has approved Peg-IFN-α and interferon-α for treatment [2]. The advantages of this type of drug are that it has a fixed course of treatment, does not produce viral resistance, has a high HBeAg and HBsAg seroconversion rate and a lasting response, and has the dual effects of regulating immunity and antiviral. The disadvantages are that it requires subcutaneous injection, is relatively expensive, has many adverse reactions (flu-like syndrome, bone marrow suppression, mental disorders, etc.), and has contraindications such as pregnancy, mental illness, alcoholism, decompensated cirrhosis, and thyroid disease.

Precautions during antiviral treatment

After being infected with the hepatitis B virus, a healthy lifestyle is very important. You should pay attention to maintaining a healthy diet and a good mental state, and exercise moderately, but avoid strenuous exercise that may cause an increase in transaminase.

Secondly, when taking the medicine, entecavir must be taken on an empty stomach, because diet can affect its efficacy. Tenofovir can be taken on an empty stomach or with meals. Pay attention to a light diet to avoid too greasy food that affects the absorption of the drug. If there is no gastrointestinal reaction when taking the medicine, it is recommended to take it on an empty stomach.

Under normal circumstances, patients need to check their liver function every three months. When the medication is first started, the number of checks is relatively high, once a week. When a stable state is reached, it can be checked every 3-6 months depending on the condition. Since the hepatitis B virus will exist for a long time, if the medication is stopped too early, it may cause the disease to recur or become serious, so the medication time is longer, which may last for several years. Therefore, patients who take medication for a long time can check once every six months in the later stage.

References

[1] Li Dongzeng. Strategies for prevention and treatment of chronic hepatitis B: new guidelines are more proactive - Interpretation of the "Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2019 Edition)"[J]. Physician Online, 2020, (4): 26-27.

[2] Chinese Society of Infectious Diseases, Chinese Society of Hepatology. Guidelines for the prevention and treatment of chronic hepatitis B (2019 edition)[J]. Journal of Practical Hepatology, 2020, 23(1):9-32. DOI:10.3969/j.issn.1672-5069.2020.01.044.