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precore mutants
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precore mutants

do all naive precore mutant patients need treatment desprite their hbv profile results (fibroscan result,hbsag value,alt,hbvdna). If yes what treatment is appropriate in this case. Waiting for any answers. Thank you in advance.
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Avatar_m_tn

the precore mutants increase cirrhosis and hcc risk so the antiviral may be justified in this case

as regards therapy my ideas is always combo of immune thereapies and tenofovir to get hbsag to go down

my own experince is A1762T-G1764A-G1899A-rtQ215Q/S-genotype D and research reports exactly what happend to me:
A1762T-G1764A-G1899A  increased hcc risk
rtQ215Q/S, high alt and cirrhosis: i had both
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Avatar_m_tn
All HBeAg negative have a precore mutants or is not mandatory ?
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Avatar_m_tn

it is not mandatory you can still have wild type, for example on wild type carriers when hbvdna becomes detectable they lose the hbeab antibody and reverse to hbeag pos

it is probably just  a matter of age and immne system potency the presence of the core mutants

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Avatar_m_tn
thanks1

so, I understand that HBeAg negative and HBV DNA detectable (even if in low replication e.g. < 1000 copies/ml) is a indication of core or precore mutation and it has to be tested?
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Avatar_m_tn

the best is make the test for precore mutants, but if you have the mutants not mixed with wild type you will never have hbeag pos again

if you have wild type you reverse to hbeag pos and hbeab negative quite often when hbvdna becomes detactable
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Avatar_m_tn
Most common test are HVB DNA and  HBeAg, and base on this test I try to determine who is supposed to make teh mutation test and who has to start the treatment.

Like ronny12 ask in the first post:
- Is needed that all patients that have precore mutant to start treatment ?

(most HBeAg negative are probably with a precore mutant and also other mutations - studyforhope estimate that 20 mutation or more (beside core precore ) are present in a long stay HBeAg negative)

So the question will be: Is needed that most patients that have HBeAg  negative to start the treatment?
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Avatar_m_tn

difficult to answer my opinion and also the lines here in italy:
check fibroscan if no liver damage or young no antivirals
check hbsag if low try interferon
try interferon at least once on patients with active hbv to see if they are among the lucky ones who clear

if genotype b and C, especially C, treatment is much better since there is too much HCC risk
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Avatar_m_tn
thanks for the answer!

anyway, like a general guideline we can say that a drug resistance test have to be done before start a nuc treatment to see what combination you have to chose.


General line in Italy are similar with general line in Europe, and they base more on liver status and age and after that on others (maybe because in Europe we have majoritary A and D genotypes )

I will continue with my question ... what means young ? no liver damage is more easy using fibroscan, but what means young ? it is 30 or 40 or 50 were is the line ?


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Avatar_m_tn
anyway, like a general guideline we can say that a drug resistance test have to be done before start a nuc treatment to see what combination you have to chose.

definitely, if i ever started lam or adv in the past (met a liver specialist instead of a researcher) today i'd have so many mutants to be mostly untreatable by nucs, my mutations rtq215s is very bad because has secondary cross resistance with almost all nucs and leads to primary resistance fast.
pisa researcher said that it usually comes with many mutations and no response is often seen with nucs.

about 10 to 20% patients have resistance mutations before starting nucs so this test can save many people, i do understnd it is expensive and some studies say the cost is too high to screen all but if you base medicine on expense you may lose many lives

maybe because in Europe....we have better doctors and little less drug makers influence

what means young ?
my opinion is that core mutants are less common until 20yo, i think brunetto in pisa made some reserach on core mutants, disease acitvity, age in a small conference held in pisa for the best world researchers only

check fibroscan if no liver damage or young no antivirals

sorry for my english, i meant they dont suggest nucs to young people because they have to take nucs for too long time and sides may become an issue.
young people have also less liver damage so they are treated by interferon and no nucs

the statistics indicate increased cirrhosis risk and HCC after 40-50yo, but this is not a rule my sister is less than 40yo and was suggested not to start any nuc for now since fibroscan was 4.5kpa.she ahsn t check the mutants because too lazy to move out of town for tests

as you may notice researchers are able to make personalized treatment and choices, so whnever possible better find a researcher.all doctors will follow researchers path but with some years delay and sometimes with mistakes



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