very good explanation of hbsag quant in iu/ml

[stef2011]

http://health.elsevier.ru/attachments/editor/file/WNH%202011/1_1_3_eng%20min.pdf

very good explanation of hbsag quant in iu/ml:
kinetics off therapy
kinetic on therapies, on nucs only tdf shown since other nucs have almost no effect on hbsag

[4est]

I think that the qHBsAg rapid decline si related to something different then the NUC type (I was reading about the persons that have rapid decline using TNF or LAm or ENT ...).
Anyway, using the latest NUC's available on the market is more safe in terms of resistance and also can offer a better chance to decline the qHBsAg.

Adding interferon is a interesting solution and I was reading that some B+ D cases cure on this strategy, so is a way to investigate.

In case of adding interferon the qHBsAg decline more faster then the case that we are using only NUC's, so in this case I can assume that our immune system have a implication in this decline, so I can assume that also in case of the people that have mono NUC's and fast decline the immune system have a good implication

just some thought!

[calmama]

StephenCastlecrag

Thank you for the link.  That is a good one.

stef2011

I hope you are right.  I look forward to more reports on this add-on interferon to existing antiviral therapy.  It's hard for me to generalize from only a few successful cases.  I need a larger number to be convinced about this 'cure' for e-negative patients.

I consider the second report (from Germany) a disappointing news about this treatment.

[stef2011]

i agree with steph, most have no reduction at all while on tdf or etv the reduction happens anyway, the fact is tdf or etv for 2-3 years rescue immune system and then it doesn matter hbsag quantity, it just goes down.we miss data on very high hbsag counts higher than 10.000iu/ml but these are rare on hbeag neg
of course the lowest levels below 1000iu/ml are cleared faster but when hbsag is superior to 1000iu/ml the lowering looks about the same:
tdf+lam+pg baseline about 1500iu/ml after 72 weeks about 300iu/ml
etv+peg baseline about 8000iu/ml  72 weeks about 30iu/ml

[StephenCastlecrag]

There are several articles about qHbsAg levels during TNF treatment. For most patients, qHBsAg levels remain very stable :-(

http://www.natap.org/

[calmama]

I am aware of all that.  I was NOT suggesting that I could use tenofovir monotherapy to clear HbsAg.  I was simply calculating how much HbsAg reduction one could have after 3 years of tdf.

My thinking is:  The results from the two reports about add-on interferon to existing antiviral treatment seemed to indicate better success rate for those with lower baseline HbsAg quantity.  So the more HbsAg reduction from antivirals, the higher probability of later interferon response.  

Facts from the two reports:
1st report:  4 out 10 e-negative patients (median baseline HBsAg 660 IU/ml, range 50-1754) cleared hbsag, 5 others had significant drops of hbsag.
2nd report:  1 out 9 e-negative patients (mean baseline HBs-Ag for all 12 patients 4,695IU/ml range 16-15,120) cleared hbsag.  This patient had a very low hbsag of 16iu/ml at baseline.  The other 8 e-negative patients had little hbsag drop and interferon was stopped midway.  (I only discuss e-negative cases because those are harder to treat and more relevant to me.)

[stef2011]

without peginterferon add-on all monotherapies have ridiculous hbsag clearance, there is no way to clear hbsag with tenofovir mono or entecavir mono
tdf is about 16% hbsag clearance on hbeag pos and about 0% on hbeag neg

[calmama]

One slide (the one before the last one) showed HbsAg decline overtime with tenofovir over 3 years.  The mean HbsAg dropped from 10000iu/ml (week 0) to ~7000iu/ml (week 144  This number is just my visual estimate from the graph) for e negative patients.  It's encouraging, but I wonder if it will keep dropping or become stablized after a few years?