and he is right we know nucs lower intrahepatic hbvdna and cccdna close to 100% by 5-10years (no effects in less than 5 years), of course the most potent like tdf the better over the weaker antivirals like etv and ban of wealest like adv, lam and so on
cd8 will recover functionality and pegg add on will restore nk cells to to clear hbv
it is all studied, proven and easy, just be patient and results will come
Forgot to say that this research done by my medical center (University of Ankara). I think I am one of the patients mentioned in the research :) However, my doctor is not the research presenter doctor.
be optimist viran b at least there are now drugs wich permit us to avoid liver damage for a long time,may be in the near future there will be a cure like the one for hep c developped recently,and this combo permit to many patients to be cured
SafiSifa, you just said that your doctor do not explains about this disease. I noticed something in this forum that almost all members have the same problem. Do you know what? my opinion, as the Steff says do not look the old posts, because the new news are coming out and even many doctors are not aware, so they are afraid to talk with patients about anything they don't know. I had last week my visit,and even though my doctor is a professor of liver, he wasn't aware for the latest news of international liver conference. I showed the link that Steff posted, and he became very optimistic. He said: yes soon will be the same thing as for hep C.
So, I think in my case,my doctor is absolutely excellent,but they are very busy with patients and they don't see every month every update, We all have to be careful and to collaborate with our doctors. Thanks god today we have all tools to keep ourself updated through internet. This is my message to you all. We should be happy because at least things have changed,we are not living as 10 years ago where it was only lamiv. we have more chances to be cured: keep in mind vitd3 and sequential treatment the thread above.
Are you sure in that these results are valid also for hbeag neg patients?
I am reading and reading again the news but I cannot find it.
Do you have more detailed sources about this research?
"192 patients who had received at least two years treatment with NUCs without achieving HBeAg loss or seroconversion were treated with 48-week combination therapy with additional Peg-IFN to on-going NUCs or NUCs monotherapy."
data is extrapolated from many studies on sequential combination treatment:
they found that hbsag loss is 91% when baseline hbsag<1000iu/ml on patients on longterm nucs, they did not clear if these with baseline hbsag<1000iu/ml before add on were hbeag pos or hbeag neg because hbsag loss 91% was correlated to hbsag<1000iu/ml
anyway i presume they were hbeag neg because with such low hbsag on longterm nucs treatment to be hbeag positive, but again it was not the reason for hbsag low so high
the data is this:
those on long term nucs with hbsag1000iu/ml had much less hbsag loss
but many other studies on sequential with hbeag negative found hbsag loss 60% and very low hbsag (less than 100iu/ml) with probable clearance in the follow-up in 90%
the message from easl 2014 conference is sequential treatment is the only treatment to increase hbsag loss to more than 60% irrespective of hbeag and reaches 91% when baseline hbsag is less than 1000iu/ml.treatment with potent nucs like tenofovir or entecavir reduces hbsag to very low levels after 5 to 10 years of treatment so most patients will be able to reach these percentages
anyway i presume they were hbeag neg because with such low hbsag on longterm nucs treatment to be hbeag positive is rare, but again it was not the reason for such high hbsag loss.the only reason was hbsag<1000iu/ml
since we have hbsag quantification we have found out that hbeag is of little utility.
In reading both studies it is obvious that NUCs have to be used for several years before INT add on, as Stef has been saying. Using both at treatments at the same time yields 30% success ( and unknown what nucs were used), while add on INT after TEN or ENT is 90% curative.
You can see that the decreased HBSag level you reach is higher for non-Asian HBeAg negative patients when using longterm NUC therapy (cf. fig 2,3 and 4). This level is the same for HBeAg positive patients independently from genotype.
totally off topic, that s simple nucs mono and useless
nucs must be followed for 5 to 10 years to see any real effect on hbsag decline, cd8 recovery, fibrosis regression and HCC risk.the hbsag decline drives everything but needs 5 to 10 years on antivirals mono
Sequential therapy is starting with NUC mono. The question is when you can add interferon to your therapy. My HBsAg is very high, I am HBeAg negative, maybe I won't reach 3 log IU/ml HBsAG value in ten years with TDF mono.
Unfortunately the above paper to this question is informative.
If somebody (a HBV researcher) would like to make impressive results he /she can select HbeAg positive patients for experimenting. You can see that the story (the NUC phase, which is the starting phase of sequential therapy) is very different for HBeAg pos and neg patients:
So for HBeAG negative treatment naiv patients the EASL 2014 results say nothing.
Naturally if your HbsAG is lower than 1500iu/ml (or using NAC for a long time and you reach this level) combination therapy is a good option for you. Independently from your HbeAG status!!!!!!
As you can see in this paper:
If you are HbeAG negative with a HBsAg value higher than 15000iu/ml you need 6-10 or more years to reach the 1500iu/ml limit value.
From this paper (http://www.natap.org/2013/EASL/EASL_70.htm)
you can see that 3.2 log iu/ ml (1500 iu/ml) HbsAG value is a cut off value for patients having combination therapy (PEg + NUC) which is the second phase of sequential therapy.
- for HBeAG negative patients (based on the two papers above and the EASL 2014 results)
first phase: 3-4 years NUC (1-3 log HbsAG decease)
second, finishing phase: NUC + PEG (further 1-3 log HBsAG decrease)
(this is the way which was followed in the EASL 2014 study!)
- for HBeAG negative patients
first phase: 3-4 years NUC therapy (only 0.5 log decrease, see the APASL 2012 paper!)
if 0.5 log decrease is not enough to reach the 3.2 log iu/ml limit value you would better to continue first phase for a couple of years to reach the limit.
second phase: combination therapy (NUC + PEG) which can finish the project.
(Stef2011 follows this path. Good luck Stef.)
If you are a HBeAG negative patient with 4.5 log iu/ml HBsAg value or more waiting for the next generation medications is a more realistic hope. It will come earlier than you reach the limit HbsAG value using NUCS.
You should start the first phase as soon as possible, the second phase more likely to be differ from NUC + PEG.
Naturally this section is for the HBeAg positive patients:
- for HBeAG positive patients (based on the two papers above and the EASL 2014 results)
first phase: 3-4 years NUC (1-3 log HbsAG decease)
second, finishing phase: NUC + PEG (further 1-3 log HBsAG decrease)
(this is the way which was followed in the EASL 2014 study!)
most studies are now checking for response after short nucs treatments and not always tdf or etv but also weaker antivirals....well in the end nothing to lose because pegintf can be retried some years ahead, but to be sure at least 4-5 years on potent nucs are needed
i also noticed tdf or etv mono look better than combos but spesific studies are needed to confirm this.on dr Ozan study, which is the only one with long term nucs 3-8 years, the only patients with slow response are on combos
This paper http://www.natap.org/2012/APASL/APASL_26.htm
says that (based on 375 HbeAg negative patients) the treatment when using TDF for 4 years can decrease HbsAg with 0.5 log in average. That is an evidence.
just see your results, maybe you arrived from 10000iu/ml to 3000 iu/ml in 3-4 years with ETV and/or TDf, that is 0.5 log decrease approximately
we dont have to wait anything these are the drugs we all use for hbv and we all must combine this way, end of story.
how can you say wait?and for what?
....stay off our drugs for the sake of investors?
Hi Stef, I mean that waiting for reliable scientific statements is important. I didn't write any new pieces of information, only summarized the facts of two old important papers and an EASL 2014 news.
Anyway I am absolutely sure in that you will be HbsAg neg in a two years time period using TDF + PEG. For me, who is HBeAG neg with 17000 IU/ml HbsAG, more likely that next generation drug will extend my TDF therapy in 3-4 years.
Hi! Kindly can you explain the means of LOG,, the equivalence with UI/ml, so for example you saying that you have 17000 iu/ml going down to 1000 iu obviously is easy math,what about log?how is converted? i am sorry but i don't have time to study this things,i already have enough other courses
let us assume that your HBSAG is 17000 iu/ml = 4.23 log iu/ml,
after applying 3-4 years NUC monotherapy your value for example will be 5000 iu/ml ( 3.69 log iu/ml),
after this phase your doc use PEG + NUC combined therapy and your HBSAG value will be 2000 iu/ml ( 3.3 log IU /ml)
From 4.23 to 3.69 means 0.54 log iu/ml decrease.
(1/3.46 of the original value: 17000 / 3.46 = 5000)
From 3.69 to 3.3 means 0.39 log iu/ml decrease.
From 4.23 to 3.3 means 0.54 + 0.39 = 0.93 log decrease.
( So addition on the logarithmic scale means a multiplication on the original scale. Sorry in case if it is too technical. Just use the converter (see the link above).)
Cheers Steff. I'm just trying to get an idea to put things into perspective for myself so once I start a course I know where I stand so to speak in terms of a cure rate. I'll be damned if I'm going to have this virus for the rest of my life :)
When using TDF mono HBsAg decrease is much higher for HBeAg positive patients (or HBeAg negative patients who were positive when TDF and/or PEG treatment started years ago).
( see Figure 4. HBsAg Kinetics among Patients HBeAG+ at Baseline
When you reach 1000-1500 IU/ml HBsAG value by applying TDF, just adding PEGASYS you can clear HBV in 1-2 years with a very high probability.
This is true independently from your HbeAG status as Stef say.
If you are HBeAG negative, treatment naive patient with relatively high HBsAG value, HBsAG decrease is more time consuming (cf. Fig. 4.).
Not all HBV carriers need treatment, just be sure for your status. Last week I made my MRI and elastography, no fibrous, no cirrous. Liver is healthy(thanks god) butI don't understand why i feel discomfort on the liver side. My dna was 223 and now went 1021. No treatment, For now I begin to take only vit D3 because is low around 30, and Steff and researchers are saying that we all have defficiency of it as a result of hbv. For now i am waiting to do my HBsag test, and still i am not sure if my doctor will put me on treatment. Anyway, at least i feel relieved because I know that we have a future, a high rate of cure
HBSAG 780UI/ml (U/ml) (half a year ago it was 1200UI/ml)
cobas e411, ECLIA, Roche - Does someone know if this is a good machine?
HBV DNA - 4500 UI/ml
Vit d - 7
Liver tests all within normal limits.
The doctors do not want to start treatment and there is no insurance because liver tests are not elevated.
vitd25oh less than 30ng/ml decreases response to all therapies peginterferon, antivirals and antibiotics both for hbv, hcv and all infections.it is best to avoid such suggestions that put health and life at risk
i dont want to disopointed all of you,but this treatement didn t work on all patients, and the rate of 91%of success is not true
my doc was in easl congress this spring and she told me tat add peg int after taking viread or years is not the sollution to clear hbv maybe few patients responce because the results are not always good and hbv is not always cleared
and the good news is that they manage fastly to find a real cure since they found one for hepatitis c
There is a conference in Toronto on November 5th and 6th, it's about curing Hepatitis B & C. Sit tight all, I think something good may come out of this one for us (since the C cure is already out there!)
I don't know about your doc if he or she understand good english, There are some clearly proven results that shows clearing hbsag with sequential therapy when hbsag is less than 1000. This therapy takes some years, and if rep9ac or arc520 will come up soon,it means that this sequential would takes no years but weeks to clear hbv,as is happening with hepc carriers
hhhhhh, she understand englsh very well
she told me that this treatement didn t work on all patients
few ones only ,it can tbe considered it as a cure for all
here in France they applied this in hospital in paris 'Beaujon)as trial and she gave me the numbers of cases wich success and those wich field about 20% only respond ,;and each country did this trial;in the easl congress the results are not very good,few patients respond and you can ask your doc
also she asks me if i want to try after taking viread for 2 or 3 years and observe hbsag value during this time ,because now i have hbsag 3700iu/ml so high it will not work now
I do not think your doctor is right. Whether you are going to respond to interferon or not solely depends on your host virus relationship. Today science is not able to explain why some respond to intf and some don't.
There is no way to know for sure but try and no reason for doctor to claim that intf will not work on you.
I dont think your doctor is talking about patients with hbsag less than 1000iu/ml by use of antivirals for 5-6years because the results are clear, she was probably talking about higher hbsag and less years on antivirals because all trails on sequential found percentages for these years and for that hbsag found clearance from 60 to 90% and these have been shwon in easl, there are no other trials with these details but only the ones published here.
for higher hbsag and little years of antivirals everybody knows even here the numbers are just little higher than mono
also think like devil........ there are investments and this thread is not the favourite of companies looking for investors like replicor and all others and there are also some doctors tied to drug companies......they ll never talk well about sequential
i always talk with her about new treatement and she gives me what real happen and give me explinations about each trial the good side and the bad side
because she is doing researches about hep b ,she is not just a hépato but also a researcher
My doctor is also a specialist of liver, chief of department of GI in NY, reseacher for a new drug on hep, but not all of them have been guiding this trial. To do a trial, It takes many years, and you can't come out with a decision or with just few patients. We believe in real facts, real numbers, real cases, real publications. All of us know that we have tenofovir and peginterferon to cure our disease but it takes years. What we want is a fast cure. And this is going to happen only after 2-3 years when rep9ac or arc520 will be on market.
you know andry;what i remark here is each one react deferently towards treatement,and this what i am trying to say and what my doc explains to me,but we cant generilise or agree that there is a sure cure for hep b
when we see hep c ,yes there is a cure with label and efficient for 99%wich works similarly on all hep c patients
for us it is related to the chance and construction of the body of each one of us
Please, if somebody has something new to say is welcome, we need real publications to spread out. My mom and my auntie has high blood pressure, and enalapril doesn't work to my mom's body.So Flyinsky, we know that each of us has unique chemistry, we are talking for general human being,and we are to finish and eredicate this virus. Sequential therapy works on 91% of people, period
Sequential therapy certainly increases the rate of HBsAg seroconversion, but I am not sure that it has been clinically proven to be as high as 91%. I do agree with Flyinsky that the therapy may not work for everyone. Some researchers believe lowering the serum HBsAg, then add PegIFN may not be sufficient to lead to clearance for everyone. We are assuming that by lowering hbvdna and HBsAg, the HBV specific T cells immune functions can be restored, Interferon can further reduce HBsAg and also modulate the immune system, so the two combined may lead to HBsAg seroconversion. We are hopeful that these assumptions are true.
Reducing HBsAg (naturally or by using REP9AC' or ARC520) to restore the immune system is not the only approach. In cancer research, they are now using anti-PD1 and anti-PD-L1 monoclonal antibodies to remove these so called "checkpoint" that is characteristic of T-cell exhaustion.
I also believe therapeutic vaccine can also boost the number of T cells if given at the right time so that they are not inhibited by viral antigens.
HBV is tricky, we need to throw everything at it to secure a cure.
i am kru from india....i took my blood test 3 months ago .......both hbsag and hbeag positive.......first i want to reduce my hbeag.because my company asking about only hbeag..........so tell me about interferon....is it suitable treatment for me...........please tell me..this is spoil my career...
your company is very ignorant anyway making hbeag negative is easier than hbsag
go for tenofovir for 1 year if hbvdna is not already undetectable naturally then add on peginterferon for another 48 to 96 weeks to tenofovir, this makes the highest chances to make hbeag negative
if hbsag is very high this may not work
This is not the cure, most doctors will not agree to this. There is no cure as of yet. May i ask how many members here have cleared hbsag using this strategy? 1 or 2 maybe. Until all doctors prescribe this and more members clear hbsag this post is toilet paper
91% clearance and 100% response in lowering hbsag was in sequential treatment with hbsag less than 1000iu/ml
no data about peginterferon mono, we only know response is highest.
there was a study on hbvdna und inactive carriers long time ago at a easl conference, they did not check hbsag quantity at that time but it was probably less than 1000iu/ml.response for 48weeks was 30%, i dont remember if 30% clearance was within 48weeks or 5years follow up
Yeah but I think the 91% was for eag positive isn't ? Also with my low hbsag And Hbv DNA around 40000 iu from your opinion how long will it take me to clear hbsag on mono therapy such as peginterfron as I never took any medicine in the past. My appointment is this Wednesday I'm just preparing my questions to the doctor just in case she ask me to take viread only
hbvdna is not so low so i d try pegintf mono for 24 weeks if no big hbsag and hbvdna decline i d go for tdf and then pegintf add on in 1 year.i think that with peg you have to try and see then correct according hbsag levels
ask the doctor for the personalized hbv treatment according hbsag levels that most expert researchers/liver specialists are applying in italy
ok great lets all take nucs for 10 years and hope our hbsag level is below 1000iu/ml then hope peg can clear our hbsag..... great stef2011.... tell me if this is so great then why have you not put it into use? post your results of this cure you speak of and we can all believe........
this is spam...... if this worked we would all be on it.....
false hope.............. stef2011 also posted alinia was the cure....... did that work for anybody? cure to make hbsag positive to negative was your words..... stop misleading people with your theories
I am in no position to speak about the treatment of hepatitis but have in mind that at least in my country until last year they treated hepatitis b just to achieve undetectable hbvdna, they just started to watch hbsag quant .if nucs can lower hbsag, in a few years it is logic that this can be possible after many years to achieve seroconversion. I didnt seen official trials on this but speaking of this, stef, do you have some links on this ? Let's hope that replicor will manage to get to the market their arc vaccine in the next years
Me, you and Steff are not scientists, nor researchers. This is said because of study done by researchers.
Professor Cihan Yurdaydin from the Department of Gastroenterology, University of Ankara, Turkey, have conducted this study and had presented on liver conference 2014
192 patients who had received at least two years treatment with NUCs without achieving HBeAg loss or seroconversion were treated with 48-week combination therapy with additional Peg-IFN to on-going NUCs or NUCs monotherapy.
Out of this population, 83 patients were treated with combination therapy and 109 patients were treated with NUCs monotherapy. All patients were followed for a further 24 weeks and the HBsAg level was measured both during treatment and post-treatment.
Where is your prof that mostly do not reduce hbsag on nucs? I think that Steff is not misleading anybody, but thanks to him we know much more about hep B. Personally I would thank him,for taking his time to response to everybody,advising them for what he has done through his experience,bringing latest news from pisa's researchers and what is reading from internet. If you have prof for your saying you are very welcome as well.
my main point is discussion that helps patients now with the cures we have available now, with such high cure rates reported we need to focus on these sequential therapies and also look in to possible improvement of response from 91 to 99%
we just need to apply this and confirm in our daily clinical experiences