HEP B Virus

[Bee55]

if both partners have HEP B and no antibody, and/or one have antibody AND mutated HEP B, can unprotected sex increase viral count in both, and does that increase damage to the liver?

[stef2011]

if you have exactly the same genotype it is no trouble at all generally but
if the replication is active you might exchange mutants in case you have many

you must find a good lab to check your genotype and mutants possibly with sensibility 5%, if both genotype and mutants or both wild type no risk to make hbv more aggressive

in my experience we have the same genotype in my family but different mutants:
my mother had wild type and after liver transplant of course cleared hbv from assays detactability
my sister has no liver damage at all better than normal population, fibroscan 4.4kpa (generally 5.0kpa), so they didn t check her mutants
me: A1762T-G1764A-G1899A-rtQ215Q/S-genotypeD, with rtq215q/s there are usully other mutants at low level
my father: cleared hbv

so in my family we do not share same bathroom with my mother and we take care about it

[goofygoatboy]

bee55 and i are partners.  she is HBVsAb -, while i am hbvsAb + so it seems she may have both the wild type and the mutant i have. we have had plenty of unprotected intecourse so it seems likely we both have the same virus except maybe i am continuously clearing the wild type. i agree we have to get genotype and mutant tests but have not yet. do you know if commercial tests are readily available for this?  i haven't found them yet if they are.

...but not sharing the bathroom?  it seems extreme, is this just extra caution on your family's part? it's understandable after a liver transplant of course, i'm just asking.

btw, i found a report today of someone with similar profile to mine (except his genotype was known to be A) cleared the virus after 24 weeks of peg-ifn.  now i am wondering if he is suseptible to reinfection with immune escape variants.

[Bee55]

Wow, thanks, you are very knowledgeable. Appreciate you taking the time. May I ask if you and your sister were contracted the virus through the birth canal due your mom having the wild type at the time?
exactly just how easy to get the HEP B virus? (not sharing same bathroom?) So far we were told, that it is blood to blood contact and sexual intercourse only, and what understood, significant amount of blood to blood (open sore). Also, that kissing alone is not enough saliva to get it.
So what you are saying is, that if my fiance has the A...B..C..D (is there more?) if I have only his genotype, and did not make my own, or even if I did make my own, but made the same genotype, than the virus is not any stronger to do more damage as we passing it back and forth through sexual contact?
Do you happen to know, what "grade 2 level 1 liver damage" means? (it is on my needle biopsy report - per "Batts and Ludwig type testing") We tried to look it up, but found no reference.

[stef2011]

but not sharing the bathroom?
yes it just us because of the transplant to avoid any possible contamination from hbv or other patogens

did she have active infection?maybe she cleared both wild type and mutant

these tests are available only at research centers, i have the mutant profile by blood test at an int'l research center in italy but resistant test to NUc drugs and precore/BCP test are commercially available everywhere although if hospital wants to save money on people's health they don t use it

infection with moderate hbvdna level: blood sex, very high hbvdna saliva, blood, sex, hbvdna und, blood

infection with mixed genotypes is much more aggressive, usually genotypes are the same in the same geografic area.as to the mutants i know about mine q215s which is quite common on genotype D, higher alt, more cirrhosis cases

there is also E,F,G, H but very very rare and in very small areas in the world

the only thing that matters clinically is fibrosis grade and among fibrosis only f3 and f4, f1-f2 has no meaning it is just artificial grading by observation but no clinical meaning, F1 and f2 are very mild fibrosis, there is also a grade for inflammation which is higher than fibrosis it is not important at all if fibrosis is little

you can also check all posts about antifibrotic food and use it in your diet to regress the little you have and prevent liver cancer

[stef2011]

A1762T-G1764A-G1899A

forgot about these mutations, they are found in 90% liver cancer and now considered as liver cancer marker so in presence of this mutant and detectable hbvdna treatment is a must

[Bee55]

thanks for all these VERY valuable information.
You said you got yours tested in Italy. Was that done by mail?
The cancer marker mutants you listed are "A" genotype?

[Bee55]

I was just reading something about how HBV can survive extreme temperatures.
Do you think it is possible to get infected I HOT SPRINGS? Me and my fiance often visit Hot Springs...wondering if that is maybe how we got the virus about 3 years ago....Also, can we possibly infect others by going to Hot Springs? (say we have a cut, bleeding type of circumstances)

[stef2011]

if there is no water treatment like in swimming pool you might get many other diseases like fungus and bacteria (the types you get at swimming pools)

as to hbv if you have cuts it is possible but very unlikly, dentists have still high percentages of hbv/hcv since it is not possible to lower it to zero despite hygenization.I've read that in  US also healthcare settings are a very big source because of wrong procedures since hospitals try to save money on anything, the other main sources are sex and mothers at birth but there is also a high percentage where the way of infection is unkown

the mutants are present in all genotypes, as for the tests i go to the main research centers which are normal hospitals for our healthcare system, you just book and go there free of charge for any blood test, ultrasound/fibroscan.
visits are made by the team of doctors/researchers, not the main researcher director brunetto.we have many researchers on hbv in italy but the best are brunetto in pisa and lampertico in milan.so in those settings you have the most updated tests, machines and drugs on trial

[Bee55]

thanks..I see...hmmm...I guess we are looking research center in the US to find out our genotype, since that is where we live. So far, it doesn't seem so simple to find one here...

[stef2011]

stevenNY suggested me harvard in boston or if you are close to LA maybe trying to get in touch with HR, if you are interested in one of these locations i can PM doctors names

[April63]

Hello, I've been reading this thread about virus B transmission between HBV carriers and I have one related question. Maybe someone will be able to help me out. Is there a scientific explanation  why there is a low risk of transmission in long term relationships? It's seem rather peculiar,don't you think? My partner of 30 years (my husband) and I have had unprotected sex for many years. His infection is one with moderate hbvdna level ( 350 000 IU/ml). I'm very happy I didn't get HBV from him. On the same note he didn't get my HCV. None of our 2 children didn't get our viruses. I'm very,very happy. Don't get me wrong but I would like to know why? I can't be just a lucky coincidence. Is there a scientific explanation of this? Thank you kindly for your answers.

[April63]

And I forgot to add that I had my vaccination against B virus only around 15 years ago.-April.

[stef2011]

there is competition for liver cells between hbv and hcv, hcv is able to suppress hbv, this might be the reason
in boston conference i read a study on this the found the hcv substance which suppress hbv

[Bee55]

thanks stefano, good to  know. my fiance will see his doctor in a couple of weeks (he just had a biopsy done today - mine was couple of weeks ago) and see if we can get the genotype identified through a test-lab his doctor can refer us to, hoping near by. We are in Idaho. If that results in more questions, and we need to have tested further for mutations, I will ask you then for names you  know. I really appreciate your help, you are a huge source of info, and this is sooo confusing to me...so I am a little scared, but hopeful, too, that there are some possibilities out there.
thanks again, I will stay online and read, and learn what I can for the time being.

[April63]

Very interesting point. Thank you, Stefano. :)

[stef2011]

as for therapy consider and find as much info as possible on interferon and nitazoxanide and avoid antivirals that work on hbvdna

there is a new interferon which is a little more potent and with less sides by the combo of these drugs you might have chances to eradicate hbv, both drugs are active on hbsag wild type or mutated, they don t make mutations or resistance, and can be stopped.i guess only having two genotypes mixed (i mean the a,b,c,d genotypes) might be a different situation from the reports of trials in lowering hbsag

i have also read, but i don t know if this is your case, that patients with hbsag mutations have lower levels and this makes eradication by alinia (nitazoxanide) and interferon much easier and faster.ask for hbsag, hbcag and cccdna/intraepatic hbvdna quantification by biopsies, this is a test which can be easily made in any hbv research university/hospital and do save your biopsies so that when more tests are available you don t need to remake them

[stef2011]

both drugs are on trial for hcv but work on all viruses since immune modulators:
interferon lambda and alinia (nitazoxanide)

the first is on trail so difficult to have but nitazoxanide is already on market for other illnesses from as early as 2000-2004 so easy to have especially as a generic from mexico or indian producers (US alinia is way too expensive)

[goofygoatboy]

Bee55 and i have no reason to believe we have two genotypes.  I was acute (symptomatic and IgM c Ab positive) about 2.5 years ago when we had been together about 6 months.  She was checked at that time and found to s Ag positive and IgM c Ab negative.  I then went on to develop the high titer of s Ab that I currently have but failed to clear the virus.  My doctors interpretation of the results (which seems correct to me) is that I caught the virus from Bee55.  We don't know whether I got the immune escape variant from her directly or if I developed it on my own when my immune system kicked in and produced the s Ab.  I guess the second may be more likely since I'm not sure why I would produce the s Ab if i was initially infected with a virus with the s Ag mutation.  

Either way, we have had plenty of exposure to each other since then and assume that whatever we have we both have the same thing.  I understand that some mutations are less replication competent and die out in the presence of wild type, but in my understanding the common s Ag mutations are roughly equally competent so I am assuming bee55 can have both.  Of course I don't know this for a fact.  Does it sound reasonable to you?

I found some papers suggesting that success (sustained off treatment viral clearance) with peg interferon treatment is considerably more likely with A or B genotype (around 45%) than with C or D (around 15%) which is why I want to know my genotype.   If success is defined as e Ag sero conversion then the numbers are closer I think.  Plus, it may be worth trying it anyway because even 15% is much higher than the chance of sustained off treatment viral clearance with the antivirals which i think is only 1 or 2 %.
Do these numbers match your understanding?  Have you gone through the interferon treatment yourself?  Also, i'm not aware of how adding alina changes the response rates, do you know?

thanks

[stef2011]

Does it sound reasonable to you?
yes perfectly.i'd just make the genotype because that's a simple routine test here, but i understand US might be different everything is free here so maybe we have a different approch on tests we just make them all if there is disease activity.
genotype is important to know interferon response, if you have a double mix of genotypes hbsag clearance rates cannot be applied.generally speaking:
peginterferon (not lambda) has 11-30% hbsag negative by 5 years
alinia (ntz) from small preclinical trials 25% hbsag eradication in one year monotherapy in hbe negative

about interferon use combo with nitazoxanide, not alone, and if possible lambda and if hbsag decreases go on with this therapy 2-3 years until hbsag gets negative.it is all off label but many doctors have done that already with normal interferon too

of course to make this therapy you need absolutely hbsag quantification, once hbsag is eradicated you must check hbvdna pcr ultraquant (sensibility 0.19iu/ml) for occult hbv which is very frequent on s variants

[goofygoatboy]

We do intend to get our genotype.  Luckily we both have insurance now.  That doesn't make it free but it means we can probably afford it.  

Is there an advantage to first using hbsag quantification and only then switching to hbvdna quantification?  I mean as opposed to just using hbvdna quantification as the primary measure.

[stef2011]

they reflect 2 different things:
hbsag, number of infected cells in the body and if decreasing immune system taking hold of more cells and eradicating virus from them.
hbv virus has a template (cccdna) inside liver cells that makes hbsag in a huge number to neautrilize the immunety antibody hbsab, this is the way it persists.in your case we can see only hbsag quantity not the antibody because there is no test at the moment but if you see hbsag down and hbvdna down you are eradicating.
cccdna maes also the complete virions and the other antigens

hbvdna reflects the virus relication but not the virions number, if it decreases there is less replication and this might reflect less virions around.hbsag/hbvdna ratio gives an idea of the number of virions produced

making only hbvdna is useless because you might have hbvdna almost zero but the liver full of cells infected by cccdna and blood full of hbsag, in any case with a very low hbsag it is not possible to have a lot of hbvdna and virions, when hbsag is zero the neutralizing antibody takes hold of virus

so you need both but hbsag is more important to know if drugs are working in terms of eradicating infection.

hbsag quantification is from 2008/9 studies made by the researchers in my hospital, doctor brunetto (a she), known well known around the world but all antivirals have almost no effect on it, only interferon and alinia

[stef2011]

i mean:
hbsag quantification importance is now well known around the world but antvirals have no effect on it except interferon and alinia

the key to eradication will be the combos of interferon lambda and entecavir or tenofovir if lambda makes mild sides

[goofygoatboy]

Thank you.  I hadn't understood that in addition to reproducing "itself" (infectious viron particles) the virus also produces a lot of non infectious surplus protein particles and that these are what are referred to as hbvsag. (wikipedia life cycle of hbv)  The same proteins (s antigens)  also appear in the infectious particles but the infectious particles may only make up around 1% of the total hbvsag in circulation (http://biology.kenyon.edu/slonc/bio38/scuderi/parti.html).  This same source says the hbveag is thought to reside on the core protein which (I think) means it is only present on the infectious viron particles, do you know if that's correct?  

You say that hbvdna reflects the virus replication but not the virons number, but that doesn't sound right to me.  To the extent that it is quantitative the hbvdna directly represents the number of circulating infectious virons doesn't it?  It seems like the hbvsag couldn't go undetectable while the hbvdna remained high unless I had what amounts to a false negative, i.e. the hbvsag test missed the hbvsag, possibly due to mutations of the s antigen.  likewise, it doesn't seem like the hbvdna could go undetectable (indicating very low viral replication) while the hbvsag (surplus proteins reproduced during replication) remained high.  what am i missing here?

i think i see your larger point though, that a major goal of treatment is that my immune system succeed in clearing the hbvsag.  In my case I guess this would mean that I developed an additional antibody that was able to bind the s antigen variant that is seemingly not recognized by the hbvsab that I already have in abundance.

I really appreciate your willingness to entertain these questions and respond to them.  I think i am slowly getting a better understanding of the disease and what kind of treatment options make sense to try in my case.

[stef2011]

both hbsag and hbeag are produced to suppress immune system, the most potent is hbsag, hbeg is not needed by the virus and is the only antigen that can go through placenta so it is thought it is a mean of immune tollerance and infection to a baby, which is the main source of hbv infections since babies have more than 90% chances to get cronic hbv and not adults.but there are many many other ways hbv escape immune response and even suppressing hbvdna is good for immune system.
in any case the main antigen blocking immune system is hbsag since hbv can be cleared even without hbeab antibodies

To the extent that it is quantitative the hbvdna directly represents the number of circulating infectious virons doesn't it?
no it has nothing to do with the virions, i don t know exact terms but i think the dna is released when a cell is infected but that cell produces many many virions and many immune suppressing antigens not just one virion, there is no direct correlation between virions and hbvdna just an idea.
all the tests that you can make in the blood gives only an idea of the infection but the only mean to really measure with high sensitivity and precision is hbv biopsy and measuring virus and antigenes directly in the liver cells

It seems like the hbvsag couldn't go undetectable while....
i m sorry i cannot understand this question but the main consideration is hbsab antibody blocks virus entrance in liver cells so you can understand the meaning of this for the virus.hbvdna can be still positive even if hbsag is undetactable but at very low levels because the virus cannot replicate since all liver cells are closed for him and ,unless like in your case there is mutation, the virus will have a very short life and hbvdna slowly und since hbv has no way to replicate

some cccdna will be left in your liver anyway but until hbsab is present the infection will never be able to start again, this is a danger only in case of transplant or chemiotherapy but both entecavir or tenofovir can block infection if started before transplant/chemiotherapy