@ThomasTu @availlant @everyone
Fibro scan is normal according to doctor
Does this mean a partial cure?
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Dear @Godsown ,
The definition of partial cure is HBV DNA < 2000 IU/mL with normal ALT for aleast 6 months after removal of all antiviral therapy. Fibroscan is not part of this definition but it is good news that it is normal. Are you currently off therapy? What is your HBV DNA?
Best regards,
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HBsAb …negative
what do you all say?
could it mean different things?
Hi @catcher.007 ,
The presence of HBsAb or not is not required for functional cure. In a prophylatic setting, the presence of HBsAb indicates protection from infection. However, as recent studies with therapeutic vaccines and NAPs have shown, the appearance of HBsAb during therapy does not constitute protection. This is because HBsAg persists which is not recognized by this HBsAb (immune escape HBsAg).
Best regards,
So, how does this work exactly? Let’s say a person gets infected in his/her childhood - as the years pass, this person will have some (more and more?) immune escape HBsAg.
Then, this infected person has blood or other bodily fluid contact with a healthy, vaccinated person who has antibodies generated by the vaccination. Will these antibodies protect against immune escape HBsAg from the infected person? Setting a bit similar to older COVID vaccines, which no longer protect against recently mutated SARS-CoV-2 variants and needed a vaccine update?
HI @mantana ,
A good question for a complicated issue - why does vaccination work to protect from infection when different HBsAg species are present in the virus which is shed by an infected person?
As we have discussed elsewhere in the forum (see here), HBV infection in any one person is actually a pool of HBV genome variants (which I previously termed quasispecies). Actually, John Tavis and I have chatted about this offline and we agree that this term is not correct (even though used widely in the literature) since these genome variants do not contain mutations which are linked to each other (so behaving like genetically conserved species) but are instead generated randomly and enriched from selection pressure by the immune system or some antiviral therapies.
So over the course of HBV infection, the prevalence of genome variants (and the HBsAg variants they generate) evolves according to the immune selection pressure from the infected person’s immune system. Fortunately, MOST of these variants will still be recognized by antibodies produced from standard vaccination. So vaccination still effectively prevents the development of infection from this viral innoculum.
Now in a person with already established infection, the pool of immune escape HBsAg is already well entrenched and can evade the vaccine response. This is why therapeutic vaccination has failed to date in all clinical trials to achieve functional cure (despite the production of strong vaccine responses).
This is different from the situation with SARS CoV2 (and influenza) where the entire viral innoculum can be entirely immune escape against a particular vaccine.
Best regards,
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Before this test I was not on therapy, it’s more than six month between when I was diagnosed and when I did this test.I couldn’t afford HBV DNA test (viral load) as at then. @availlant
HI @Godsown ,
I understand the unfortunate difficulties in getting access to an affordable HBV DNA test. However, without this test, it is not possible to assess if you have achieved partial cure or not. HBV DNA levels reflect the level of viral replication going on in the liver and we need this information to make this determination (and also to decide if therapy should be started under current guidelines). You liver function appears normal (good) and you have also achieved HBeAg seroconversion (also good). HBV DNA levels are typically (but not always) lower in patients with HBeAg seroconversion. Its hard to give you more information than this.
Best regards,
Hi Availlant and all experts,
I was reading article reference ncbi.nlm.nih.giv defines partial cure with detectable HBsAg but persistently undetectable HBV DNA in serum after completion of a course of treatment. Could you pls provide your input on this?
Also why qHBsAg is important to test in HBeAntigen negative and low vermia patient (which I think is called inactive phase). Pls provide your input.
Hi @staystrong ,
Partial cure is defined as HBV DNA < 2000 IU/mL with normal ALT in the absence of any therapy. HBV DNA can be detectable. The important criteria is that there is no liver inflammation (normal ALT) as well as well controlled (but not totally suppressed) viral replication in the absence of therapy.
Several clinical trials have shown that the likely hood of establishing partial or functional cure of HBV with withdrawal of NUC therapy increases when HBsAg becomes < 100 IU/mL and more so when HBsAg is < 10 IU/mL. These low levels can only be determined using a quantitative HBsAg assay.
This being said, no person reading this post should think that it is safe to stop NUC therapy unless they have undetectable HBsAg and have consulted with their doctor.
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Thank you Availlant for your detail response. Could you pls when you said normal ALT, is this the normal range defined by lab who tested the blood work or defined by specific country guide like, like in Europe I think is 40 or 45 and in US is 35 and in some Asian country is 55. Pls provide your input.
Also if a person who has low viral load less than 1000IU/ml, consistent normal ALT for 6 months or so but has mild to moderate fibrosis, will person be considered under partial cure?
Dear @staystrong ,
You are correct regarding normal ALT.
After viral replication is effectively suppressed, either under NUC therapy, or with the establishment of partial of functional cure, the reversal of fibrosis is a slow process occurring over many years. So it is possible for a person with partial of functional cure to still have fibrosis. This is not so concerning a situation anymore since the liver is slowly healing.
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Thanks Availlant for your response.
Hi Availlant
As you mentioned viral load less than 2000 IU/ml with consistent normal ALT defines as partial cure. My question is how the experts come up with 2000IU/ml threshold for HbeAntigen negative carriers. Is there
any article or research that explains this?
Dear @staystrong,
Much of the work on viral load and liver disease progression has come from the REVEAL study (large scale analysis of people in Taiwan with Hepatitis B). This study found that disease progression is proportional to HBV DNA levels and below 2000 the rates of liver cancer, cirrhosis and death during the follow-up period (13 years) were similar to those with below 60 IU/mL.
Hope this helps,
Thomas
Thanks Thomas, so what is the risk % /probability of disease progression / LC for patient HBeAntigen negative carriers? Is there any article or research that you could pls refer?
And also with Genotype D carriers
Totally agree with Thomas here.
Last year I found out I had hepatitis b when I went to donate blood. They said it wasn’t serious and I should contact my doctor and they can not take my blood. I’ve finally had the courage to see the GP all they did was forward me to a specialist. I feel like my life is finished, the person I wanted to marry I can not because they are in the health profession and I don’t want them to lose their job in case they catch it.
Btw I’m 36 years old, had a career change into gas engineering I smoke, I use to drink heavy, I don’t drink anymore. What worries me is also how did I get it who may I have given it to.
So many questions and I have no one I can speak to it about. So much stigma
Hi @Ashton
There should not be a problem in marrying from a medical point of view, current vaccinations for HBV is effect at preventing transmission. I am also hoping for a functional cure in the future. There are extensive research being done on the field of functional cure for HBV and hopefully they will solve the problem.
As for stigma, as much as it sucks, we have to become more personally strong and carry on the struggle until the situation improves.
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