Improving immunity can self-cure hepatitis B

This sentence is not completely correct, but it is definitely not a rumor - after adults are infected with acute hepatitis B, more than 90% can achieve self-healing through normal immune response. This group of people can fully recover as long as their immunity is scientifically adjusted, and they do not even need additional antiviral treatment.； However, for patients with chronic hepatitis B infection, there is currently no evidence-based medical evidence to prove that 100% self-healing can be achieved simply by improving immunity. To achieve clinical cure, antiviral treatment and immune regulation are usually required, and individual differences are huge.

Let me tell you something real that I encountered in the liver disease clinic last year. Xiao Zhang, a 32-year-old Internet operator, was tested positive for hepatitis B surface antigen in his work unit. The HBV-DNA quantification was 7th power, and his alanine aminotransferase soared to 230. It was found that he had an oral ulcer while drinking on a business trip half a year ago and was accidentally exposed to the virus. He was in the acute hepatitis B infection stage. 他当时怕吃抗病毒药要吃好几年，纠结了半天跟医生商量先试试免疫调节的方案，回去直接把熬夜改方案的毛病戒了，每天雷打不动11点前睡，把原来顿顿吃的重油外卖改成了家里带的杂粮饭加清蒸鱼、新鲜蔬菜，每天晚饭后绕着小区走40分钟，也不跟朋友出去喝酒撸串了，三个月回来复查，病毒量已经阴转，谷丙转氨酶降到了32，再过俩月查，表面抗原都没了，还出了乙肝表面抗体，属于完全自愈，连医生都夸他的免疫细胞“争气”。

But if you ask an infectious disease doctor about this case, you will most likely get two different answers. This is also the core reason why this topic has always been controversial.

Many doctors who follow the conservative treatment route will directly advise you not to gamble: self-healing of acute hepatitis B is a normal outcome for most people. For patients with chronic hepatitis B, the annual natural self-healing rate is less than 1%. If you don’t take medicine with the mentality of "you can get better by improving your immunity", if the virus continues to replicate and damage the liver, and eventually develop into cirrhosis or even liver cancer, who will be responsible?

This is really not an alarmist statement. Last month, I treated a 48-year-old patient with chronic hepatitis B. He was diagnosed with the infection almost 10 years ago. He has been refusing to take antiviral drugs. He eats various health products at home every day, which are said to "boost immunity", such as Cordyceps sinensis and Ganoderma lucidum spore powder. This time, the aminotransferase was re-examined and it directly rose to over 400. The liver test showed that he had reached the second stage of fibrosis. Instead, he had to be hospitalized first to protect his liver. The gain outweighed the gain.

However, there are also many liver disease doctors who study immunity who do not agree with the theory that immunity is useless. Their logic is very simple: all current hepatitis B antiviral drugs, whether entecavir or tenofovir, essentially suppress viral replication and cannot completely remove covalently closed circular DNA (cccDNA) in liver cells. In order to ultimately achieve clinical cure, that is, the surface antigen turns negative, it is still necessary to rely on the own immune system to recognize the infected liver cells and remove the virus hidden inside. The interferon currently used clinically is essentially an immune modulator, used to activate the autoimmune response. Many real-world research data show that for advantaged groups that meet the indications, combined with interferon treatment on the basis of oral antiviral, coupled with scientific lifestyle adjustments, the clinical cure rate can be increased to 20%-30%. This is essentially an extended application of "improving immunity to help achieve self-healing".

Many people have problems with their understanding of "improving immunity". They think that they must either take expensive supplements or practice to death. In fact, this is not the case at all. I met a young man in his 20s before. After he was diagnosed with chronic hepatitis B, he went to the gym every day. He would not leave until his whole body was sore after training. As a result, after three months of training, he was reexamined and found that the viral load did not drop. Instead, the transaminases increased due to rhabdomyolysis. To put it bluntly, the immune cells in your body are like guards stationed in the liver. You usually feed them junk food, stay up late every day until they have no strength to stand guard, or suddenly let them follow you to excessive exercise and consume them internally. Let alone fighting the virus, you will be in trouble yourself.

The things that are really useful for improving immunity for hepatitis B patients are actually trivial things: get enough 7-8 hours of sleep every day, don’t drink alcohol, don’t eat health care products with unknown ingredients that may damage the liver, set aside three or four hours a week to do some moderate-intensity exercise, such as brisk walking and Tai Chi, and don’t stare at the indicators every day so anxious that you can’t eat. These are more effective than health care products costing tens of thousands of dollars.

Having said that, there is no need to worry about the right or wrong of the sentence "whether immunity can cure hepatitis B by itself". If you make good adjustments during the acute infection period, you will most likely be able to successfully turn negative.； Those with chronic infections should not ignore it. Take antiviral medicines when you need them, and adjust your living habits accordingly. Even if you don’t wait until you recover, you can still control your condition well and be the same as a normal person. Isn’t that enough?