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1738923 tn?1327330269
HBV Mutations
Just read HBSAB and HBSAG double positive is possible and it's usually caused by an immune-escape(?) strain? What are the factors that will create one? Im HBSAB- and HBSAG+ myself, so im assuming what i have is one of the "common" ones.

To Stef and others, can u please explain?

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Avatar universal

immune pressure and some weak nucs like lamivudine, adefovir and telbivudine can make this mutations

in italy the hbsag mutants test is available in some hospitals: policlinico tor vergata rome, cisanello pisa (brunetto research laboratory) and san raffaele milan.maybe others have this test but for now i have found it at these hospitals

if hbsab is negative is very unlikly to have mutants, some dna polimerase mutations are linked to hbsag mutations too that's why resistance due to antivirals is very dangerous and combo is always a good thing

interferon is also responsible for hbsag mutants when monotherapy so i'd avoid making interferon mono too
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1738923 tn?1327330269
immune pressure? What does that mean?

i also read i read from the the medhelp HBV readme that interferon doesnt cause mutations.

http://www.hbvadvocate.org/hepatitis/factsheets_pdf/Treatment-first.pdf

"Because interferon is not a direct antiviral medication, people who are treated with it do not develop drug resistance. "

I also read that majority of these double positive HEPB carriers are immunosuppresed.
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Elimination of hepatitis B virus surface antigen and appearance of
neutralizing antibodies in chronically infected patients without viral
clearance

Z.-H. Zhang1,5, L. Li1, X.-P. Zhao1, D. Glebe2, C. M. Bremer2, Z.-M.
Zhang1, Y.-J. Tian1, B.-J. Wang1, Y. Yang1, W. Gerlich2, M. Roggendorf3, X.
Li5, M. Lu3,4, D.-L. Yang1

Article first published online: 31 AUG 2010

DOI: 10.1111/j.1365-2893.2010.01322.x
© 2010 Blackwell Publishing Ltd
Issue

Journal of Viral Hepatitis
Volume 18, Issue 6, pages 424–433, June 2011

Summary.  Seroconversion from hepatitis B surface antigen (HBsAg) to
antibodies against HBsAg (anti-HBs) usually indicates resolution of
hepatitis B virus (HBV) infection. Here, two HBV-infected patients with
seroconversion to anti-HBs were found to be persistently positive for HBeAg
and HBV DNA. Immunohistology of liver biopsies confirmed the expression of
HBV proteins in the liver of one patient. The neutralizing ability of
anti-HBs in patient sera was demonstrated by blocking HBV infection of
primary tupaia hepatocytes. Analysis of the HBsAg-encoding region of HBV
isolates from patients indicated the coexistence of heterogeneous HBV
genomes in patients. The majority of recombinant variant HBsAg was reactive
in HBsAg assays and was able to bind to anti-HBs. Circulating immune
complexes (CIC) of HBsAg in patient sera could be detected by polyethylene
glycol precipitation and trypsin digestion. Thus, neutralizing anti-HBs may
appear in chronic HBV carriers for long periods but does not necessarily
lead to complete viral clearance.
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1738923 tn?1327330269
another question

doe engerix and other HEPB vaccines protect one from ALL hepb strains? Or those with mutations will get through vaccinations?
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1738923 tn?1327330269
and does it have an effect on sperm? WHat if a person in baraclude therapy wants to have kids? Should he stop taking them for the mean time or is it totally safe?
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Avatar universal

studyforhope explained this muatnts perfectly in entry inhibitors post

immune pressure means that when immune system targets hbsag the virus just mutates that and so escape immune system.hbv vaccine doesn t cover this mutations.
it was said interferon makes no mutations but that was a wrong early ipotesis because they only checked the dna genome of hbv, now we have tests on hbsag and hbcag and research is made a more competent way.lso remember that drus makers say only what they want from trials so their trials have very poor value, they only tell you the good part for them....so as researcher double check results many new things come out like interferon making hbsag mutants, it doesn t happen often but it does happen and also monotherapy has no meaning for us as patients, it is just a way for government or insurance co to save money

in the end we will have india with cheap drugs and combos for patients (all tests are available already there) and US as the worst place to cure poeple...so it worths look there for affordable drugs combos
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so hbv vaccine can t protect from hbsag mutants

and does it have an effect on sperm?
no

WHat if a person in baraclude therapy wants to have kids?
no effect on having babies or transmitting to babies, also the virus likes us to have babies......

Should he stop taking them for the mean time or is it totally safe?
no it shoudln t be stopped, hbvdna in the sperm does not infect the baby.it is important that the mother is vaccinated to avoid infection at birth

if you are hbvdna und there is no hbvdna in the sperm but the mother must be vaccinated anyway because it is safer.you can infect mother but not baby, it is only the mother to infect the baby at birth if she is a carrier
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1738923 tn?1327330269
thanks stef :)

where do HEPB escape mutants come from? Aside from those who took lamivudine and/ or immunosuppresed. Are they much common with HBEAB + or HBEAB - people? Or doesnt matter what the HBEAG status of  a person has?

******************************

oh btw pls drop by this thread I made

http://www.medhelp.org/posts/Hepatitis-B/-FOR-REFERENCE--What-are-the-tests-for-HEPB-carriers/show/1603343

this is to simply have a centralized thread on what tests a chronic HEPB'er should have :) i want you to add more info on it :)
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where do HEPB escape mutants come from?

they just happen after many years of immune pressure on hbv antigens, but they are rare

as said they are rare, not even worths checking studies are very very few.researcher told me interferon or interferon combos can eradicates these forms which can be weaker than wildtype
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1738923 tn?1327330269
Thanks for the info. :)

im assuming that the higher the viral load of one has the higher the chances of having a mutant escape strain right?
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no the contrary if off therapy

while you may be correct on some type of immune therapy
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1738923 tn?1327330269
no the contrary if off therapy

while you may be correct on some type of immune therapy

**************************************

- what do you mean?
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if you are not on therapy and have high hbvdna the immune system is weak and the virus doesnt need to mutate and doesnt mutate.we can say he is quite smart.so off therapy these mutants are so rare we dont even need to menthion them

when you are on immune therapy and you respond withan active immune response on hbsag the virus is pushed to mutation.if hbvdn is very high you have more chances to make this mutation
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1738923 tn?1327330269
oh ok i get it now, lemme rephrase it.

when there is no direct attack on the HBV then therefore the virus doesnt need to mutate and isnt pushed to "adapt" to the NUCS/ treatment.

BUT
if one is under treatment and also has a high HBVDNA count then the virus may be pushed to "adapt" and mutate to survive the treatment.

so a combo of peg + antiviral is best to have multi-pronged approach against the virus and also the virus is attacked from different angles and wont have time to mutate and adapt against it.
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