Superinfection Therapy – Rewriting the Antiviral Playbook

Greetings everyone!

I am Tibor Bakacs, MD, PhD, DSc, CSO of HepC Inc (https://superinfectiontherapy.com/). Here I summarize our research findings on a paradigm changing antiviral platform technology, the so-called Superinfection Therapy, which could provide a new hope for chronic hepatitis B patients (see references at Blog/News – Superinfection Therapy).

What if the safest antiviral wasn’t synthetic—but a harmless virus itself? We proposed first ‘Fighting Fire with Fire’ – harnessing a naturally occurring, avirulent avian vaccine virus, the Infectious Bursal Disease Virus (IBDV) to fight pathogenic viruses. IBDV could be developed into an off-the-shelf “antibiotic” for viruses. From fighting viruses to empowering the host is a scalable, disruptive approach to antiviral therapy poised for rapid growth.

The problem is that viral diseases remain a top global health threat—with limited treatment options. Most antivirals target the pathogen, making them prone to resistance and narrow spectrum. Pandemic preparedness is constrained by pipeline development time and lack of scalable, rapid-response therapies. Scalable antiviral therapies are urgently needed because the next influenza pandemic is inevitable.

IBDV reprograms the host’s innate immunity, not the virus. IBDV induces host-protective pathways, not inflammation. IBDV has been demonstrated to be safe and effective against five different types of viruses (hepatitis A, B, C viruses, SARS-CoV-2 virus and herpes zoster virus) in more than fifty patients.

New hope for more than 250 million chronic hepatitis B (HBV) patients

As current drugs only suppress but cannot eliminate the virus, we proposed a two-step treatment that mimics how healthy immune systems naturally fight off HBV. The goal is a functional cure—meaning the virus becomes undetectable and stops causing harm, even if some traces remain. First, the immune system should be kickstarted by using the harmless IBDV that triggers a powerful interferon response. This helps shut down HBV replication and reduces the viral load. Then, exhausted immune cells should be rebooted by following up with ultra-low doses of two cancer immunotherapy drugs: nivolumab and ipilimumab. These drugs help “wake up” the body’s HBV-specific T cells so they can finish the job. The immunotherapy combo has been safely used in cancer patients at ultra-low doses.

A doctor, a patient, a breakthrough

The immunostimulatory power of IBDV superinfection therapy can be best demonstrated by my own severe herpes zoster episode. Imagine waking up one morning with searing pain in your head and around your eye, your vision threatened by escalating infection from the skin into the eye and knowing that conventional treatment might not work fast enough to save it. That was my reality. At 75 years old, I faced herpes zoster ophthalmicus (HZO), a severe form of shingles that attacks the eye. The swelling around my orbit was so intense that I knew I had to act fast (see picture and video).

The CSO of HepC Inc’s HZO with orbital edema at the peak of disease and in recovery. The selfie pictures were taken between October 9, 2021, and October 12, 2021. Consent to the publication of patient information was granted by Tibor Bakacs, M.D., Ph.D., D.Sc., as he was the patient and the treating physician in his autobiography.

Standard antiviral treatment, acyclovir, typically takes two weeks to heal herpes zoster. In older patients, however, as virus-specific host immunity declines with age acyclovir often fails entirely. I had only one chance to protect my eyesight. As both a medical doctor and researcher, I decided to complement acyclovir with the experimental oral IBDV therapy, which is developed by my company. The result? My recovery was astonishing—within just a few days, the painful blisters crusted over, a visible sign of healing that normally takes two weeks on average.

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Hi @TiborBakacs,
Thank you for sharing your work. I hope you are feeling better now. I am fascinated by this. When you say “IBDV has been demonstrated to be safe and effective against 5 different types of viruses”, some of us might think that 50 patients is not a large sample enough. What do you say to that? And are there any attempts being made to test this on a larger sample of people (100’s or 1000’s? Thanks, Bansah1

Dear Bansah,

Thank you for your interest. I completelly agree with you. Please note, however, that as a small biotech company with limited resources, we rely on visionary supporters and collaborators—academic scientists, advocacy groups, patients and forward-thinking insurance companies—to help us accelerate:

Critical Research & Development – Advancing antiviral therapy and proving its efficacy.

Rapid Prototyping & Clinical Trials – Ensuring accessibility and scalability of this life-saving technology.

Global Pandemic Preparedness – Creating an antiviral solution that protects against future outbreaks.

Best wishes, Tibor

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Hi Tibor
Very interesting work in IBDV superinfection Therapy. Do you envision short and longterm consequences of this approach? Would this trigger HBV specific response or basically non-specific immune response? Am imagining severe detrimental / off target effect when combined with Immune check point blockers.

Thanks

Tom A

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Hi Tom,

No, I do not. The reason for this is evolutionary. The more distantly donor and recipient host species are related, the more difficult it will be for any virus to jump between them and establish a productive infection. Key components of the virus–host interaction in birds and mammals diverged along with their hosts during more than 200 million years such that 13 mutations may be required for avian influenza viruses to establish productive infections in humans. For such gigantic jump influenza virus requires an intermediate host, the swine, to pre-adapt to humans. IBDV does not have such a natural biotechnology laboratory. Not unexpectedly, no zoonosis cases were ever reported in workers of chicken coops and/or IBDV vaccine production facilities over the last 60 years during IBDV mass vaccination programs in poultry. The World Organization for Animal Health (WOAH), explicitly state that IBDV has not been reported to have any zoonotic potential.

Consistent with this, IBDV replicates poorly in patients and mammals. In fact, long-lasting remission has been achieved in decompensated chronic hepatitis patients only if large IBDV doses has been administered continuously over a long period of time. No treatment associated significant toxicity was reported. Importantly, IBDV treatment never induced an excessive release of pro-inflammatory cytokines, even though patients with decompensated liver disease had high-level viremia, which is a key driver of the cytokine storm. A striking feature of IBDV therapy was the regeneration of the cirrhotic liver over several years of follow up.

IBDV therapy is not HBV specific. The viral dsRNA activates the native antiviral interferon (IFN) gene defense system of the host cells. In such a way, IBDV has been proven to be safe and effective against five different families of viruses: hepatitis A, B, and C viruses (HAV, HBV, HCV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and herpes zoster viruses (HZV).

We proposed sequential targeting of the innate and adaptive host immune responses in chronic HBV patients. Long-term suppression of HBV replication and hepatitis B surface antigen (HbsAg) production will be achieved first by IBDV therapy that induces a strong innate immune response. Then, the exhausted HBV-specific T cell function will be restored by blocking the cytotoxic T lymphocyte-associated antigen-4 (CTLA‐4) and programmed cell death protein 1 (PD‐1) receptors with immune checkpoint inhibitors (ICIs). To minimize any risk of toxicity, off-label low doses of nivolumab (0.5 mg/kg) plus ipilimumab (0.3 mg/kg) will be administered, the safety and efficacy of which has already been demonstrated in 131 unselected stage IV cancer patients. We predict that this combination therapy will provide sustained off-treatment virological and clinical responses during a relatively short treatment period.

Tibor

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Hi Timor,

Thanks for taking your time to explain in details. I look forward to this interesting therapeutic approach in HBV.

Best wishes

Tom

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