Proposal for treating Chronic Hep B

I proposed this to my doc last year. He ignored it, mostly, saying that it cannot be done and that he does not have a license to experiment on me. I wonder if anyone here has come up with the same idea, and have tried bouncing it off your doc.

Anyway, my proposal is based on the fact that people with HBV Genotype A respond the best to interferon based therapy (compared to genotypes B, C and D). Anyway, I had proposed that we start draining off my blood (Genotype D infested) periodically, and in large quantities, and replace it with blood that has a large concentration of HBV Genotype A. Soon, in a few weeks or months, I would have a thriving colony of Genotype A. Then begin interferon based therapy. I surmised that this would respond very well to medication. I would be far more likely to 'e' seroconvert and 's' seroconvert. And because of seroconversion, I would fight off the remaining HBV Genotype D on my own and quite effectively.

Besides the obvious risks associated with getting myself pumped with several litres of blood from several strangers, I do not see any downside to this.

Too late for me now: I have finished my 48wk PEG-IFN. Do some of you want to propose this to your docs?

[bberry]

crazy thought, sharp

you are suggesting draining a "large" volume of your blood periodically. two dangers in one. i dont think it may be possible to do it periodically in a speed that you would like.. would harm your body that way i think.. also draining large volumne of blood might cause other problems even if given back the same amount of blood from someone else..

i dont know.. too gloomy a picture to draw.

but i will tell you this. i will print this out as you've written it and will hand it to a world renowned hepatologist i am meeting with in a few weeks. if there is a doctor that can tell you this is good or not then it has to be this doctor.

[Sharp7]

I like coming up with crazy thoughts :-). If I share some of my other crazy thoughts for treating it, you would be glad I am not a doctor -- you would propose I become a butcher instead :-).

Since I don't know medicine that much, I cannot put numbers on what "large" quantities would be safe for blood or for viral loads.

Thank you for offering to run it by a renowned hepatologist!

[zellyf]

Researchers do not completely understand the role of genotypes, there is some thought that they can change over time, they just don't know.  I doubt you could find a doctor to do this. Are you basing this hypothesis on a good understanding of the virion?

[Sharp7]

Given the risk of pumping in other peoples' blood, and that too in large quantities, I think we can be fairly certain no doctor would do it on a patient. However, if the idea itself is a sensible one, perhaps they can do it on monkeys first, publish a few papers and then do something. It's a pity no good research is going on for HepB in India (I checked a few places) otherwise I would have gone to some big-name doctor here and given him this proposal. I would even have offered myself as one of his first human test subjects :-).

Several journals have shown that with interferons, the effectiveness reduces from A to D, exactly in that order. One example paper that talks about this: http://gut.bmj.com/cgi/content/full/54/7/1009
I have come across several other research papers that show this variance in effectiveness to interferons across genotypes. I downloaded the papers more than a year ago. I'm kinda lazy to find out the online link to each of them and paste here :-). But I will gladly do that if it interests you (or others)!

Perhaps you can think of it as the way many vaccines work. For example, the way humans react to cowpox virii vaccinates them against smallpox. You can think of this as a kind of extended vaccination: get a different variant of the disease (genotype), treat for the easier variant to induce anti-body creation. The more virulent disease then gets eliminated by anti-bodies.

[Sharp7]

forgot to add: though they have repeatedly seen this difference in effectiveness of interferons, researchers have seen no such pattern (so far, that I know of) with nucleot(s)ide analogs.

[NashPred]

I’d be scared I would come away being infected by both genotypes for good. I know there have been people on the HCV forum that had been infected with 2 different genotypes at the same time…but not on purpose and I guess the same thing is possible with HBV.

Why not just get blood put back in from someone who has already cleared the virus and has a high amount of anti-bodies? Has that been tried before? Seems like I read about adding blood with antibodies being tried before or maybe it was just an idea that has been discussed here in the past….I can’t remember.

I am genotype “A” and did 48 weeks of Peg IFN and didn’t “s” seroconvert (I was already eAg neg).
Interesting idea but I would be to chicken to be the guinea pig.

[Sharp7]

I too remember vaguely about injecting just the anti-bodies directly. I think I saw some doctor on one of the forums here comment that. I think the conclusion was that the amount of anti-bodies that need to be injected to make this work this way is so high that it is practically not do-able. I have not read any research papers about this.

"Interesting idea but I would be to chicken to be the guinea pig. " your choice of words reminds me of a story :-). http://www.implementingscrum.com/2006/09/11/the-classic-story-of-the-pig-and-chicken/

[zellyf]

I understand that there is a difference in effectiveness but the thing is that they aren't quite sure WHY.  There is limited scope of understanding of the why genotypes are meaningful although there is acknowledgment that they ARE meaningful.  There are too many unknown variables.

[Sharp7]

I agree - as far as I know, researchers have not come across any explanation of why interferons behave differently with different genotypes. Much worse (again, as far as I know) they don't even completely understand how interferons work against HBV. One article says "The mechanism by which interferons exert their antiviral effect is complex and not yet fully elucidated." and another says "... The clinical relevance of these in vitro activities is not known."

However, my point is only that I see value in trying out some steps in what *seems* to be the right direction, without fully understanding what is going on. Maybe too risky to try on humans right away, though.

[bram44]

Hi bberry - did you talk to the GI on this ? Any new findings ?