Introduction：I have not a good time to discuss the problem of antiviral therapy, because of how to make the patients receive health educatio
I have not a good time to discuss the problem of antiviral therapy, because of how to make the patients receive health education and disease evaluation period, it has a lot of great difficulty than I thought.
Now I find that health education and psychological counseling to the patients of chronic hepatitis B comrades, will receive health education from passive to active learning and application, so as to lay a good foundation for non drug intervention patients body, not only directly improve the quality of patient's daily life, don't spend what money, but also can give doctors a real test the inspection results, and the formation of doctor-patient trust and patient role gradually increased and the implementation is guaranteed to restore. That's the biggest thing I've ever done.
However there are impatient friends shouted everyday antiviral treatment, I sometimes have been done not have the patience to explain, but I will stick to my own practice standards to operate, do not accept the front half of the condition assessment and the doctor-patient relationship reconstruction patients, the sub antiviral money consuming time I can order not willing to take responsibility Oh, lest make chaos poop engineering.
A comrade, consciousness of anti retroviral therapy has studied, so I gave him the task, to calculate a hepatitis B individuals, if antiviral treatment persist, without considering the cost problem, please calculate the various outcomes of individual treatment in probability. And what is the corresponding expenditure?
Nearly half a month later, the patient is really deliver the goods, write the following stuff, I have been feeling not moved. So I put this article here, and lay the foundation for future evaluation and improvement.
What is the probability that an individual will be able to face and how much will it cost?
Antiviral therapy include interferon and nucleoside drugs for two categories.
Interferon is divided into two kinds of common and long-term. Interferon therapy for a year, that 4 randomized controlled trials of HBeAg negative patients, at the end of treatment, the response rate was 38%~90%, but the sustained response rate was only 10%~47% (average 24%), cost about 10800 yuan (Kaiyinyisheng 5 million, 60 x 180=10800 yuan). Interferon treatment for one year, the treatment (87% for Asians) for 48 weeks, the withdrawal of 24 weeks of follow-up HBeAg seroconversion rate was 32%; the rate of HBeAg seroconversion was 43% withdrawal of 48 weeks of follow-up, cost about 60 thousand yuan (Pegasys 1260 x 48=60480 yuan). Check the cost of a year is also a lot, about 2400 yuan.
The whole process of nucleoside drugs treatment is divided into three periods: the period of intensive treatment and maintenance treatment period and prolonged treatment to avoid relapse. Different periods have different requirements, different requirements are to avoid drug resistance.
What are the requirements for intensive treatment?
During this period, the HBV DNA was reduced to 1000 copies.
How can we achieve this? Before the start of therapy must be checked, according to serum levels of virus drug selection: 7 HBV DNA more than 10 of the patients, can choose the potent drug entecavir (Runzhong 190 x 48=9120 yuan) or telbivudine (hormone downs 156 x 48=7488 yuan); 6 HBV DNA less than 10 of the patients, can be used to pull Miff (He Puding 190 x 24=4560 yuan) or A Duff Vee (who was 155 x 24=3720 yuan).
How long is the intensive treatment period? Different drugs have different time, why? Such as lamivudine and telbivudine will be 9 months after the gradual emergence of drug resistance, so it is necessary to reduce the virus after less than 1000 copies. If you do not reach this target, you should change or add A Duff Vee. Use of entecavir in most patients within 9 months of the virus is reduced to less than 1000 copies, if not, should also be combined with A Duff Vee.
A Duff Vee therapy in patients with E antigen positive, 1 years HBV DNA may not be reduced to less than 1000 copies, thanks to the resistance in 1 years can continue to small to medium, for a short period; but the treatment of E antigen negative patients need to limit the index reached within 1 years.
How to maintain medication during treatment?
Although the copy of HBV DNA is less than 1000, but still "big 3 this world".
The period from the "big 3 this world" to "small sanyang". The conversion time nucleoside drugs are very slow, each drug is slightly different: entecavir and telbivudine and lamivudine over 20% a year, slightly less than 20%, A Duff Vee is only 12%, so usually takes 3 to 5 years. Before the treatment is "small Sanyang" hepatitis B, hepatitis B virus has mutated, the recurrence rate is very high, this period should be longer.
Although HBV DNA 1000 copies, due to the domestic detection is not sensitive, in fact, there is a very low level of viral replication, if there are 800 copies, such as a copy of the 500......... Although the prevalence of drug resistance is low, there is a possibility.
Generally, patients can be treated with lamivudine and A Duff Vee combined treatment, drug resistance is generally not within 3 years; well-off patients want to continue to use entecavir can also better combined with A Duff Vee.
How to avoid the use of drugs to prevent recurrence?
This is the "small three", but still can not stop, more than 80% of patients will relapse after drug withdrawal, so to extend the treatment, the current treatment of nucleoside drugs at home and abroad there is no provision of treatment, drug withdrawal must be discussed with the doctor.
This is the "small Sanyang", HBV DNA < 1000 copy also has 3, 5 years, may have very low viral replication. May be used as a drug is enough, the cheapest drug adefovir, too, may be a long time application.
If calculated at 8 years, entecavir (Cave Runzhong 9120 x 8=72960 yuan) or telbivudine (hormone downs 7488 x 8=59904 yuan); Lamivudine + adefovir (Heptodin 4560 * 8=36480 + 3720 yuan are * 8=29760 yuan, 66240 yuan). Inspection fee of about 15000 yuan. Fortunately, the money is not single, installment, so the economic pressure is not large.
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