Loss of HBsAg antigen during treatment with entecavir

[Ann8]

In conclusion, this retrospective analysis of data from a randomized, international phase III trial shows that the rate of HBsAg loss was approx. 5% in nucleoside-naïve HBeAg-positive patients treated with entecavir for up to 120 weeks. Parameters of response demonstrated a sequential pattern of ALT normalization, HBV DNA reduction to <300 copies/mL, followed by HBeAg loss, HBe seroconversion and HBsAg loss. Most patients who experienced HBsAg loss had achieved HBV DNA <300 copies/mL, ALT normalization and HBsAg loss by week-48 of treatment. Importantly, sustained suppression off-treatment of HBV DNA was demonstrated in those patients who exhibited HBsAg loss.....

[bram44]

Great question - as people say, when they do not have sure answer :)

As per the treatment guidelines :
a) For HBeAg+ patients the end point in treatment is converting to HbeAg-

Then what ? Are they clear - by no means NO.

b) For HBeAg - patients there is no sure endpoint other than losing HBsAg

[jhakas]

Iam getting more and more confused .. some say being HbeAG - ve ( without treatment ) is good .. while some say that HbeAg + ve patient gets less treatment and get cured ?

What is good to have hbeag +ve or hbeag - ver

[bram44]

Here is one recent document explaining the efficacy of various treatments (including Herbal/non-anti-viral):


http://www.hivandhepatitis.com/cme/2009/easl/PostEASL09_NL_FINALPDF.PDF


Page#7:
Chinese Herbal Formula for the Treatment of CHB
Over many years, plants of the genus Phyllanthus have been used in
the aqueous extract form as traditional remedies for the treatment of
CHB in China and India. Studies suggest that the mechanism of action
of P. amarus may be related to inhibition of HBV polymerase activity.
Thyagarajan and colleagues previously reported that 59% of 37 patients
with CHB cleared detectable HBV DNA 2–3 weeks after the end of a
30 day treatment period with P. amarus. [Thyagarajan SP, et al. Lancet
1988;2:764–766]
In a well-designed, randomized, double-blind, placebo-controlled trial
the anti-viral effects of a Chinese Herbal Formula (Phyllanthus
Compound) in 90 patients with CHB were investigated. [Zhou DQ, et al.
Abst. 933] Patients who were HBeAg-positive and had serum HBV
DNA levels greater than 7 log10 copies/ml were randomized (2:1) to
receive Phyllanthus Compound (n=60) or placebo (n=30) for 48 weeks.
HBV viral suppression was significantly greater among patients who
received the Phyllanthus Compound (3.4 log10 copies/mL) compared to
those who received placebo (0.1 log10 copies/mL) (P <0.01). Further,
undetectable HBV DNA (<3 log10 copies/mL) was achieved in 13 of the
60 patients (21.7%) in the Phyllanthus group compared to only 1 of the
30 patients (3.3%) in the placebo group (P < 0.01). HBeAg loss and
seroconversion were observed more frequently in patients receiving
the Phyllanthus compound than placebo (HBeAg loss: 12/60 [20%]
vs. 1/30 [3.3%]; Seroconversion: 9/60 [15%] vs. 0/30 [0%]). While
preliminary, these data suggest that Phyllanthus Compound may be
effective for the treatment of CHB, resulting in viral suppression and
HBeAg seroconversion in some patients.
Anti-HBV activity of Simvastatin and Synergistic Interactions
with oral nucleos(t)ide analogues
Although not in clinical trials, another potential treatment may be the
use of HMGCoA reductase inhibitors (statins). Bader and colleagues
have previously reported that simvastatin (SIM) has significant antiviral
activity in vitro against wild-type and drug resistant HBV with inhibition
of both extracellular virions and intracellular DNA intermediate forms.
Building on these observations, a study was performed to assess the
antiviral activity of combinations of SIM plus LAM, ADV or TDF and
to determine potential additive or synergistic effects. [Bader T, et al.
Abst. 552] Using a Hep2.2.15 cell line model, the investigators reported
that the combination of SIM with LAM or TDF demonstrated a moderately
synergistic antiviral effect. In contrast, the combination of SIM
and ADV resulted in additive antiviral effect against HBV replication.
Although these combinations have not been tested in vivo, these findings
suggest the potential role for the combination of currently available HBV
agents with the generically available statins, including drugs like SIM.

[therese1234567]

please keep us updated for the latest findings of the treatment, I just hope and pray that this disease will soon be eradicated. and complete complete healing will be expected so we can also find better jobs as others. With confidence we can face them without fear of discrimination. Thank you for the hope. GOD BLESS!

[xxriver]

good news.

but 5% is still low, and only for eantigen positive patients.

[Ann8]

HBV patients....pls do not feel despair. Drug is getting better. Latest findings were :

i) HBsAg loss is possible and getting higher and higher both for eantigen -ve & +ve......ETV and TNF

ii) Possible remission after 3 yrs antiviral treatment % is also getting higher and higher...even with ADV.

iii) Resistance profile understanding is getting better.....

With this trend going on....very soon we will be o.k.