Aa
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.
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
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
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 ?
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 ?
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
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?
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?
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
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?
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?
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
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
Have an Answer?
You are reading content posted in the Hepatitis B Community
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
