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Loss and Seroconversion of Hepatitis B Surface Antigen after Vaccine Therapy

Loss and Seroconversion of Hepatitis B Surface Antigen after Vaccine Therapy in Chronic Hepatitis B Patients Treated with Nucleoside/Nucleotide Analogues  

Stefano Brillanti, Liboria Laterza, Paolo Cecinato, Franco Bazzoli
Division of Gastroenterology, University of Bologna, Bologna, Italy

HBsAg to anti-HBs seroconversion represents the definitive virological end-point of treatment in patients with chronic HBV infection. Unfortunately this event rarely occurs even after several years of therapy. AIM of this pilot study was to assess whether vaccine immunotherapy may induce HBsAg loss and anti-HBs seroconversion in chronic hepatitis B patients treated with nucleoside/nucleotide analogues (NA).
Methods: Among 113 HBeAg-negative adult patients on NA monotherapy for longer than 12 months, all with HBV DNA levels > 2000 IU/mL and HBsAg levels > 1500 IU/mL before starting treatment, 10 consecutive patients with normal ALT values, undetectable HBV DNA levels (< 25 IU/mL) and HBsAg levels < 250 IU/mL were selected. Five patients were randomly assigned to recive HBV vaccine therapy: 3 doses, one month apart, of 40 mcg yeast-derived recombinant hepatitis B vaccine (HBVAXPro, Sanofi Pasteur MSD), while 5 patients continued NA therapy without vaccination. HBsAg and HBV DNA status was assessed 6 months afterwards.
Results: Characteristics of the 10 patients: HBV genotype= A/D: 2/8. NA therapy: Lamivudine (2), Adefovir (4), Telbivudine (4), median treatment duration: 19 months, median HBsAg level: 48.3 IU/mL. Treatment duration and HBsAg levels were comparable between the two groups. Six months after the third dose of HBV vaccine, HBsAg loss occurred in 2/5 patients and HBsAg to Anti-HBs seroconversion in 1/5 patient. No HBsAg loss and/or seroconversion was observed in the 5 control patients. HBV DNA remained undetectable in 9/10 patients.
Conclusions: This pilot, proof-of-concept study indicates that in HBeAg-negative patients with chronic HBV infection, who experience a complete virological response and a significant decline in HBsAg levels during NA treatment, HBV vaccine therapy may enhance HBsAg loss and anti-HBs seroconversion.

Assigned speakers:
Dr. Stefano Brillanti, University of Bologna , Bologna , Italy

Assigned in sessions:
07.06.2013, 08:30-17:30, PT-4, HEP B Clinical, Exhibition Hall
13 Responses
Avatar universal
Forgot to mention that this is from APASL 2013.
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Japanese were doing this for a while now.

There was a study there where they were giving vaccine to people on lamivudine every month and some people also lost surface antigen.

What we really should look here at. As to why this happens in some people and not in others. .look into peoples immune systems. Over all body toxicity. And whether or not CMV or EBV antibodies are present.

Some researchers say that those that are infected with CMV have usually poor responce to .HBV therapy. Because CMV really stresses out the immune system.

These  co factors  So far no one is looking at. It is not about just the virus itself but also the structure of  of immune system and the amount of other pathogens  one may have.

Chronic Candida infections. Lyamblii. CMV in some people EBV causing issues like chronic fatigue  syndrome. All this is an immune dissfunction.
Avatar universal
And when you add HBV to it it even complicates things even more.

But they are not looking into this at all. Simply stating the facts that x number of controls have lost surface antigen on so and so therapy.
Avatar universal
Instead of what they should be doing is examining immune systems of individuals with high success rates and drawing conclusions. Highly specific and advanced tests are available for it. That can analyze  the immune system.

I blame.big pharma. They know it all how and what works. Because they have molecular biologists work for them. But then again is anybody these days interested in cures.? Based on my experience no. Disease management yes. Lifetime nucs for us. Is all that is in store.
Avatar universal
Thank you for posting this presentation stephencastlecrag.

Stephencastelcrag, steff and study for hope.  

Note it is a double dose vaccine protocol.  Vaccine HBSag also contain no DNA or mRNA.  So it is safer for inducing immunity.  Add on peg interferon would make this even more successful.  I think this is done for those who have primary vaccine failure.

Do you guys think it is safe to keep injecting vaccine in these cases?  I just fear alumium toxicity if you go pass 3 of these double dose vaccine.  Aluminium hydroxide is used to anchor the vaccine.      


Avatar universal

there is a way to make this vaccine therapy stronger, the use of imiquimod cream in the area of vaccine injection, since the combos on intf and the sequatial treatment with intf add on are getting more common we will see many, i hope me included, needing hbv vaccine when hbsag is very very low like less than 250iu/ml

another thing to look for:
are there very good brands of hbv vaccine without preservatives like mercury and other toxic substances?
Avatar universal
Bless you for helping many people.  However, I do advise against you trying too many oral substance which may not work.  Each oral substance can alter the creatinine in blood test.  Imiquimod should be ok. I shall see if i can find a hbv vaccine without any toxic substance.  
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Hi Veteran

I though ibesartan is a good add on for you.  Although steff saids it does not work to reduce HBSag.  There is some association about reducing cirrhosis.  It will also reduce your blood pressure.    
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I cannot answer your question, it is way beyond my knowledge.
Avatar universal
Do you guys think it is safe to keep injecting vaccine in these cases?  I just fear alumium toxicity if you go pass 3 of these double dose vaccine.  Aluminium hydroxide is used to anchor the vaccine.    

there are studies on transplanted patients give monthly hbv vaccine and lower doses of cyclosporine/immune suppressive drugs to make hbsab without using Hbig.i think they used vaccines without dangerous preservatives

the best hbv vaccine is in israel pharmacies but i cant find ingredients online to see what preservatives are being used


Avatar universal

do you think the israel hbv vaccine may have a therapeutic result if used with aldara cream monthly in a patient with slow hbsag decline?

or maybe used after pegintf treatment with low hbsag like 1000iu/ml to finish clear the remaining hbsag?

i guess they already made some research on this in israel
Avatar universal
We need to find clinics or doctors that will be willing to do this.. I can't believe that on this busy forum there is no one from research clinics is not willing to help people.

we have not problem in traveling to other countries. Israel yes has one of the best antiviral research programs.
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