As someone who doesn't have Hep B, and who knows very little about this virus, I have several questions about being in a relationship with a man who informed me he's an inactive Hep B carrier

Dr. @john.tavis I just came across this article on medical express is this something you are part of? this sound promising:

Indiana University School of Medicine researchers have uncovered vital insights regarding a liver trigger that blocks an undesired immune response from gene therapy, surprisingly resulting in activating specific immune cells despite the liver’s typical role in suppressing immune responses.

The findings, published in Molecular Therapy, may pave the way for change in immunomodulation strategies for desired and long-lasting effects of gene therapy.

Gene therapy treatments involve replacing or introducing a healthy copy of the flawed gene that’s causing the genetic disease. The process is often accomplished through a viral vector—in this case, a small, harmless virus called adeno-associated virus (AAV), which carries the healthy gene to deliver it to the target organ. Unfortunately, a notable challenge in conventional gene therapy approaches lies in the immune system’s tendency to reject certain treatments.

“Occasionally, gene therapy can prompt an adverse immune reaction when the body mistakenly perceives the treatment as a viral threat,” said Roland Herzog, Ph.D., Riley Children’s Foundation Professor of Immunology at IU School of Medicine and the study’s lead author. “Our goal is to explore innovative approaches in gene therapy, striving for methods with higher success rates to benefit patients.”

The latest research, led by Herzog and Sandeep Kumar, Ph.D. of the IU School of Medicine’s Herman B Wells Center for Pediatric Research, found that certain immune cells, called cytotoxic T lymphocytes, can sometimes be triggered in the liver despite the organ’s immune suppressive properties.

Surprisingly, and different from what was known about these immune mechanisms in response to AAV gene therapy, Kumar found that the receptor for a cytokine called interleukin-1 was critical for triggering the response that may result in immune rejection. Importantly, the team was able to prevent the immune response by blocking this pathway. These findings signify an important step to ensure more targeted and controlled immune responses.

“Our data showed that though treatments targeting the liver provide a roadmap for safer and more precise gene therapy options, additional immunomodulation strategies might be needed for long-lasting therapeutic benefit,” said Kumar, the study’s first author and an assistant research professor of pediatrics at IU School of Medicine.

The study’s implications extend beyond liver gene therapy, as the group’s findings offer a promising direction for future clinical applications that may benefit several genetic diseases.

“The concept of preserving gene therapies by blocking certain immune responses can be applied to many genetic diseases like hemophilia, lysosomal storage disorders, and metabolic diseases,” Herzog said. “This breakthrough is incredibly promising for the field, and we eagerly anticipate its broad adaptation in clinical trials, medications, and gene therapy protocols.”

I’m not involved in this work, although I am quite familiar with gene therapy concepts and approaches. Gene therapy has the potential to address a lot of genetic illnesses, but the potential for adverse effects is high because there is no way to turn off the “transgene” delivered by gene therapy once it is in a person. However, the limitation for most experimental gene therapies, particularly ones targeting cancer, has actually been not inducing strong enough expression of the transferred gene, so the work to suppress immune responses against the transferred gene or vector (AAV in this case) may improve efficacy.

John.

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Thanks you Dr.@John.tavis

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I’m not sure about this, as repeated exposure would probably increase your anti-HBs antibody levels as well. I think the scientific data on this is not clear.

Anti-HBs antibody levels are what increase your protections against Hep B correct? Would repeated exposure (potentially) increase those levels because your body is fighting it off each time it’s exposed to the virus? I feel like I read that repeated exposure (might) increase anti-HBs antibodies somewhere else online, but I cannot recall where I saw that

Yes, to get viral load tested at least once a year is the general consensus for good monitoring.

Thank you - my partner asked these questions (she’s negative, I’m a positive carrier) but I’m reading through these answers (and will let her know you responded). That said, I’m a little ashamed to admit that I do not know my viral loads. I was likely tested in the past as I recall a doctor mentioning something about how it was “almost like I didn’t even have it” in regards to my Hep B status - which makes me believe I have (or at least back then had) very low viral loads.

I intend to go get tested for my viral load ASAP. Is there anything in particular that may cause an increase in one’s viral load? Or is reactivation of Hep B really the only thing that would cause an increase?

Edit: Forgot to mention - thanks for addressing our concerns / questions! This has helped ease a lot of concerns we’ve both had about pursuing a relationship! I was on your bio / looked you up online and you seem highly, highly qualified and intelligent, which brings us even more ease. Appreciate this online community you’ve built

Good morning everyone.
I hope you are all having a good weekend, and would you kindly look at my blood results?
I hope I’m not disturbing (too much) with my question.
I just received my recent blood work ( don’t have the HBV DNA PCR in yet as it takes longer)
I’m quite upset :-(( since my liver enzymes went up from last blood work done in September.
the only mistake I can think of is I had breakfast before having the blood test done, can this influence the results?
Thanks you so much for your time and answer. @Caraline @Bansah1

just a little history I was diagnosed in June 20203 with Acute Hep B its now 6 months.

Hi Gregory,
You don’t have to be upset because you had breakfast before the lab work. Eating before your test will more likely only affect your blood glucose in this case (CMP and LFT tests)but not your liver function test.

Yes, there is a large spike in your numbers from September to what it’s in December. Are you dealing with an acute or chronic infection? Have you had any abdominal ultrasound done between these two tests? If that is normal and shows no changes, then maybe your provider can check for other muscles aside the liver getting damaged. These proteins are released into the blood stream whenever there’s a muscle damage and we have plenty muscles in our body. It could be possible that this increase is not due to your liver but rather a different muscles. Your provider has to investigate further to determine what is going on.

From time to time our numbers can fluctuate, except yours has increased a lot within 3 months. For example last year my numbers for ALT were 160 and 125 just like that but this year it down to 80 and then to 55 now for my ALTs. I do get a lot of fluctuation from time to time for my ALTs, but it doesn’t appear that is the case here.

I understand you are upset and frustrated, but please take it easy and never blame yourself for any of these numbers fluctuating. We don’t have 100% control over that. I will advice that you make a call or have a meeting or reach out to your provider as soon as possible and discuss this with him or her.

I hope you are able to work with your provider and get further information/answers about what is going on here. Thanks, Bansah1.

Thanks you @Bansah1 i was diagnosed on June 29 th 2023 and was told by doctors I had acute Hep b. Since then I have had monthly blood test and although slowly AST and ALT have gone down just this latest blood test had a spike. I had ultrasound in July and my liver was in good condition. The doctor started me on Todd at the end of October because the viral load was high ( so it’s now 5 weeks on antivirals) The only muscle I’m in pain at the moment is my shoulder/neck ( and was thinking it might be symptoms from hep b) I did show my lab work to a doctor friend ( not hepatology’s) and she said that it can be fluctuations. I’ll have to show it to my hepatologist I’m just waiting for the HBVDNA pcr since it wasn’t ready yet.

Misspelling sorry I started to take Viread in October

That is interesting. Do you know what your hepatitis B surface antigen status is? At some point if you cleared it that should become negative. Talk to your provider and see if he has a clearer picture on exactly what is going on.

Your friend was right about the fluctuations of these numbers. They happen a lot than you will imagine.

Keep us posted when you get some clarification after consulting with your provider. Best, Bansah1.

@Bansah1 I can’t thanks you enough for your generosity in taking the time to answer me, it means a lot to me, I’ m new in this lonely experience and very confused, scared and ignorant.
from the blood work done in September I was positive to both HBVeag and HBVsag.
why? do you thing there could be some movement in the serology?
I should be getting the HBVDNA PCR in the coming days and with that i should also get to know the HBVeag and HBVsag status.
and I still want to do an abdominal ultrasound
thanks you again.

Try not to over stress yourself. We all started from being ignorant about this disease until being diagnosed, then we had to learn. So don’t feel bad about it. I also understand it can be a lonely process which many of us can identify with. It gets better after a while. It’s my pleasure to respond as often as possible.

If surface antigen was positive, then it means you are still infected. And you said it’s been 6 months already, which makes me wonder how true the diagnosis yourself acute infection is. I hope it’s an acute infection and you still have time to recover. Let’s also hope that your follow up tests will confirm this.

I am sorry you have to go through this. I hope you can get to see your provider soon. It will be helpful to get his insight as it pertains to your case. Thanks, Bansah1.

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@Bansah1 its definitely being diagnosed as acute Hep B by my doctor.
I was in hospital for 5 days end of June beginning of July I had very strong symptoms ( fatigue, weight loss, and a lot of joint muscle pain ln June and have lingered in July and August.
just recently I started to feel physically better since I started TDF really.
my six months of acute just ended in November getting into December.

the reason my doctor started me on Antivirals before the end of 6 months ( acute phase) because my viral load was in the millions and AST and ALT high also.
the doctor given the guidelines didn’t want to risk further liver damage

My doctor thinks that from acute I have gone chronic since she hasn’t seen any immune response or seroconversion to the virus during the past six months.
( I should have the confirmation to that once I’ll receive the tests in few days) .
sorry for the messages shower :pensive: and thanks you again

Oh wow, that sounds like you were up against it back then. It’s amazing how some people really can get sick and others not. Let’s remain hopeful for a better results soon. Hang in there.

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I am reading through this conversation to see if I can learn anything new since I’m getting notifications bc it’s on my original post and I just wanted to say - it’s so comforting and admirable how supportive you are to complete strangers on the internet. You seem like a great person! :slight_smile:

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I couldn’t agree more!! kind, generous people are rare to find. It’s so heartwarming especially when you are dealing with a pathology such as Hep b. I’m so grateful always and amazed!

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Hi @Anon2023 and Gregory,
I appreciate your kind words. Let us say I am a big believer in the golden rule. I was not able to get any help or support like this when I was diagnosed in 2014. I am glad I can be helpful to others who have just started this journey. It can be a lonely journey, and my contribution is to provide support as much as I can to others. Oh and root for everyone. We are always here and all of you can count on our support when possible. Bansah1

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Correct.

This is complex and dependent on a lot of interactions between your liver cells, the immune cells, the virus, and your environment (and probably 1000 other factors). This is still under research, and we cannot point to anything definite that will increase your viral load in usual situations.

Thanks! I appreciate the kind words.

Sorry to hear about the stress over your recent results. Yes, it looks like a sustained high ALT and something that might indicate liver injury. This can be a sign of the immune response trying to get rid of the virus. The ALTs will likely go down back to normal over time as the Viread controls the viral replication. As long as you are keeping close monitoring, discussing with your doctor, and feeling OK, you’re doing what you should be doing.

Please don’t take these results as a personal failing. They are there to help you improve and protect yourself, not judge yourself.

Hope this helps,
THomas

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