from boston conference 2010
etv is the most potent on hbsag as monotherapy, the 1mg dose is also the most potent as hbvdna suppression (maybe telbivudine a little more potent but not safe because of high resistance rates), etv is also the only one with hbsag seroocnversion on hbe negative
etv+tnf the most potent both for hbsag and hbvdna suppression
in my case the most is due to alinia because when i lowered alinia to 1g daily hbsag jumped to 7200iu/ml immediately even if hbvdna was und, but in any case i think it is a combo synergy because if etv didn t lower hbvdna the effect on hbsag cannot be so much since new liver cells get infected all the time and more hbsag produced, at least the decrease would be slower
one thing is certain tnf makes zero hbsag seroconversions on hbe negative while etv does and this can be good news just for the alinia combo, we are talking about 3% hbsag seroconversions and 19% that get a hbsag lowering, as you said too little to even think etv alone can do something
There is another research in the same meeting concluding that anti-virals have no effects on hbsag. Even if 3% is true for etv, it is still too insignificant for us to count on. I am more interested in the interferon research, which concludes that for hbeag- patients, hbsag reduction is more than hbeag+ patients. Both reductions are ~ 3.x log10. I will try to consult my doctor for a hbsag quantitative test (in US unfortunately) to see if I have chances (< 3 log10 iu/ml) to try interferon.
also interferon alone is useless on most, only 11% seroconvert, the best strategy is a combo all all the drug at the right time according to situation and when hbvdna is very low or und interferon plus alinia can make the difference
at my research center they are waiting to see if hbsag gets to 1000-1500iu/ml because interferon has high rates of seroconversion in this case, if hbsag is higher it is a waste of time
on hbe negative interferon can be useless if hbsag and hbvdna are high, in that case it is better start with entecavir or tenofovir and when you reach hbsag/hbvdna values tht can make a good response on interferon add-on or switch slowly interferon
hbe neg with a good interferon response had low hbsag, low hbvdna and high alt, there was already a minimum immune response henanced by interferon, if this immune response is zero interferon can de very little.the only tool to measure a minimum immune response is hbsag quantity, unfortunately there are no tools to measure immune response other than hbsag
In the same meeting abstracts, there is a paper emphasizes the needs of individualize the treatments for different patient. It is especially true for hbv because the cure is so immature that individualized treatments may get a portion of patients off hbv before a definite cure is found. So I think any people who are suitable for interferon should get a try since the percentage of hbsag loss is highest. It may even higher if we only count cases of hbsag < 1000 iu/ml, which if is considered to be the criterion for possible hbsag loss.
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