Is Cure coming in future?

General Discussion
61

Hi @CNN,

Unfortunately, the terminology surrounding outcomes from treatment are a bit confusing. There are currently two outcomes from therapy which do not require treatment under current guidelines:

  1. Partial cure: HBV DNA < 2000 IU/mL with normal liver function in the absence of antiviral therapy. This is akin to “inactive HBV infection”

  2. Functional cure: HBV DNA and HBsAg are not detectable with normal liver function in the absence of antiviral therapy. For this outcome to persist, removal of most of the liver cells with integrated HBV DNA has to occur.

Both of these outcomes occur because immune control of HBV infection has recovered. This recovery is obviously much stronger in the case of functional cure.

So in the recently presented extended follow-up from NAP treatment of chronic HBV infection, overall immune control was maintained at 78% (this was present at 1 year of follow-up) but the proportion of patients who had functional cure of HBV increased from 39% at one year to 56% at 5.3 years.

HCC risk is the lowest in patients who achieve functional cure after antiviral therapy. Can HCC risk be eliminated, we are not sure but HBV DNA integration is the primary driver for HCC; the removal of these hepatocytes leading to functional cure must be having a positive impact.

Best regards,

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62

Very promising outcome at year 5!!
Thanks @availlant for the update!!

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63

Pls help me understand some few questions

  1. Does functional cure means complete elimination of the virus including cccdna

  2. How possible is the cure such that it won’t reactive

  3. Can we be confident to have a cure in the next 2-5 years

  4. Will the various combinations of drugs in clinical trials help to achieve a sterilize cure

  5. What’s your view about promising drugs coming

Will be glad to know these answers

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64

I am not a medical professional, but I may be able to answer some of your questions as a lived experience person.

No it doesn’t. My understanding is the virus is not attacking your liver, functional cure. But it is still in your blood and can reactivate.

65

Dear @CSKAY,

I’ve moved your question into this thread about cure (please feel free to read the other responses to get a broader idea about what’s going on in this area). To answer your questions:

  1. The clearance of cccDNA from the liver is the definition of “complete cure”. We have made a video of it here: What do we mean by Hepatitis B cure? - HBV Cure FAQs
  2. Also explained in the video above.
  3. Explained in these video here: How possible is a cure for Hepatitis B? - HBV Cure FAQs; What could a Hepatitis B cure look like? - HBV Cure FAQs; What do we need to achieve a Hepatitis B Cure? - HBV Cure FAQs. Essentially, we are closer towards a cure, but I think having one ready and available to people within 5 years is going to be tricky and require a lot of investment in the area.
  4. Again, explained in the videos above. More than likely, the first few approaches to cure are going to require combinations of drugs.
  5. There are quite a few coming up: Hepatitis B Foundation: Drug Watch

Hope these help,
Thomas

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