New drug 'functionally cures' many hepatitis B virus infections

https://www.science.org/content/article/new-drug-functionally-cures-many-hepatitis-b-virus-infections?user_id=66c4bf745d78644b3aa57b08

by gmays • 1 month ago

287 48 1 month ago

science.org

TZubiri• 1 month ago

Are treated patients still contagious?

If so, if a treated patient spreads the virus, will that new patient carry an innoculated virus? Or will they suffer a standard infection?

Perenti• 1 month ago

I'm pretty sure that if the virus and its DNA are undetectable then you can't spread it. I believe that's how it works with HIV anyway.

deadmutex• 1 month ago

if the virus and its DNA are undetectable then you can't spread it

The devil may be in the details. E.g. if a COVID test shows negative, it doesn't mean that you can't spread it. This is partly because different tests have different sensitivities.

I'm pretty sure

FYI, without citations, it is hard to distinguish credible experts vs people on the internet saying "trust me bro".

abc123abc123• 1 month ago

Ahh, the classic corona fallacy. If you have something, X, which you cannot detect. Then you can count it as zero, since all you can do, is speculation not backed by any empirical evidence. If there is something you can detect and measure, then, we can start the great a mighty process of science.

sleepyguy• 1 month ago

A patient that is functionally cured shouldn't pass on the disease. Since it is cleared from the blood and the viral DNA is undetectable, it is not replicating anymore, so it can't be transmitted. They risk is not absolute since the dormant virus is still genetically encoded in the liver.

rustyhancock• 1 month ago

For now all one can say is transmission is assumed to be dramatically reduced.

The bigger risk is likely that in some the suppression is temporary or transient flares of replication under some circumstances.

The other question is, does this avoid all the sequela of HBV. It seems to reduce risk of cirrhosis atleast.

For hiv, it took many decades to be able to make the clam undetectable = untransmittable using serodiscordant couple studies.

altairprime• 1 month ago

(Meta note: This exposure scenario hinges on whether the second party has previously completed the HepB vaccine schedule. So, for those evaluating this risk equation, duly noted that a vaccine exists that the yet-uninfected party above could have received.)

amwet• 1 month ago

Pretty sure the cover image is a Strokes album cover.

burner420042• 1 month ago

Is This It

My sister, who is two years younger, was in 8th or 9th grade when this album came out. She's also a Weezer and Radio Head fan. Only a few years difference but I feel this genre came after me.

efields• 1 month ago

For the American market and the October 2001 release, the cover art of Is This It was changed to a psychedelic photograph of subatomic particle tracks in a bubble chamber.

https://en.wikipedia.org/wiki/Is_This_It

halapro2• 1 month ago

I'm surprised that they're working on HB cures since there's been an HB vaccine for 40 years.

I'd love to see more work done towards other incurable viruses like HSV (no vaccine) and HPV (limited vaccine)

tfourb• 1 month ago

There are > 800.000 yearly deaths due to hep b.

https://en.wikipedia.org/wiki/Hepatitis_B

Yes, there is an effective vaccine but not everyone has access to it for tons of reasons.

chimeracoder3• 1 month ago

Yes, there is an effective vaccine but not everyone has access to it for tons of reasons.

Also, about 3.5% of the world's population already has it. That's about 300 million people for whom a vaccine is pointless, and who are at dramatically higher risk of liver cancer (somewhere between 15-50% lifetime risk of an extremely deadly type of cancer), and for whom a cure would literally be life-changing, if available.

Centigonal• 1 month ago

Herpes viruses like HSV are notoriously difficult to target with medication bc they encode themselves into DNA inside the nuclei of long-lived human nerve cells. Between outbreaks, they basically exist only as rogue DNA floating inside mostly-healthy cells in the nerve ganglia. At some point, something triggers the nerve cell to transcribe the rogue DNA, producing new viruses and beginning a new outbreak.

mrtesthah2• 1 month ago

IM-250 (Adibelivir) is a helicase-primase inhibitor that targets latent HSV so well it may actually permanently reduce the pool of viable latent HSV genomes.

chimeracoder3• 1 month ago

It's estimated that 300 million people have HBV. HBV is currently incurable once acquired, at which point the vaccine is irrelevant.

The HBV virus is also carcinogenic, which makes it unique[0] among the three big hepatitis viruses. Liver cancer is extremely aggressive and fast-killing, often reaching terminal stages before it is even detectable at all. It is one of the top three causes of cancer deaths worldwide.

Aside from the sheer number of people affected by this, it is also a horrible thing to experience. I have watched someone die from liver cancer, and I would not wish it on anyone.

Contrast to HSV, which is widespread (approximately half the population has at least one HSV latent infection) and causes very few problems beyond occasional irritation in virtually all cases that do not involve other comorbidities or immunocompromised status. HSV is also suppressible through antiviral treatment, making it generally untransmittable (if treated and suppressed) and unlikely to cause symptoms. Most people with HSV do not even bother to do this, which is if anything a testament to how little HSV affects their lives (most don't even know they have it, and there is no clinical justification for routine testing in otherwise healthy patients).

Of all infections pathogens for which I could wish a cure into existence, HSV would be extremely low on my list.

[0] While HCV can cause cancer if left untreated for a long time and if it causes cirrhosis, approximately one third of people clear HCV infection in the acute stages without any lasting ill effect. Of the remainder, it takes a long time for cirrhosis to develop, leaving plenty of time for treatment. First-line treatments are approximately 95-99% effective. So there is no clinical reason HCV needs to increase a person's risk for cancer, as long as they have access to medical care. The same is not true for HBV.

NDlurker• 1 month ago

https://pubmed.ncbi.nlm.nih.gov/39956964/

Link between HSV and dementia

ElProlactin• 1 month ago

...HSV would be extremely low on my list.

I think this is a bit of an unfair conclusion.

First, while you're correct that most people who have HSV have few symptoms (if any), you're discounting the fact that, because so many people are infected, there are millions upon millions who have highly-visible and highly-painful infections. Many of these people struggle with relationships and mental health as a result.

Second, HSV is associated with higher risk of HIV infection for obvious reasons.

Finally, discovering effective treatments for such a difficult virus would probably produce insights that have implications for other difficult-to-target viruses.

So I don't think we should dismiss HSV on the basis that it's so common and doesn't cause life-threatening symptoms. Medicine should pay adequate attention to infections that affect quality of life for large numbers of people.

Billions are spent on treatments for super rare diseases, many of which are terminal, and in the best cases the end result is often that pharmaceutical companies have drugs costing tens or hundreds of thousands of dollars that extend life by months (often with dubious quality of life).

nomel2• 1 month ago

They didn't give it to males, and didn't let males get it, until recently.

Gigachad• 1 month ago

Australia has been giving it to everyone for quite a while now. Last I saw, the virus is almost completely eradicated.

cassepipe• 1 month ago

Aren't you confusing with HSV ?

OneDeuxTriSeiGo3• 1 month ago

You are confusing it with HPV (human papillomavirus). Hep B is a very different disease.

The first Hep B vaccine in the US is given to all infants within 24 hours of birth (unless the child is already positive for Hep B or severely underweight). And then the second vaccine a month or so later and the third between ages 6 and 18 months old. Hep B vaccination is one of the most common vaccinations received in the US.

And also as a fun little fact the first Hep B vaccine was given exclusively to gay men for a decent while until it was deemed safe enough for the general population. It was also manufactured from the blood of gay men and needle based drug users.

The Hep B vaccine that came later was recombinant and that one was given to everyone from day 1 and that's the vaccine that's been more or less the main Hep B vaccine in use up to today. Recently there's at least one new one that has been approved but the original recombinant Hep B vaccine is still regularly given.

tialaramex• 1 month ago

So, assuming that you specifically latched on to the mention of HPV, which isn't even the same virus, "until recently" depends on the country and might mean 6-10 years ago in European countries or even as much as 15 years in other places.

The vaccines are not a prohibited drug and so in most places if you have full blown prescribing rights (e.g. a Doctor or most "Advanced Practitioner" roles) the prescriber can "go off-piste" and just prescribe anything they believe is appropriate. So it's wrong to say it wasn't "allowed".

What you're thinking off are vaccine recommendations which are shots you'll get badgered to do if you don't ask and those didn't include people assigned male at birth in many countries at first because the studies were about Cervical Cancer and obviously most people assigned male at birth do not have a cervix because that's quintessentially female anatomy [Mother Nature doesn't give a fuck, with billions of humans all kinds of weird edge cases arise]. Later studies checked that, as you might now expect, preventing HPV infection also avoids warts and other cancers induced by this virus, and thus impacts humans who don't have a cervix.

Georgelemental2• 1 month ago

The HB vaccine unfortunately doesn't work that well, many people are still not fully immune even after several doses

chimeracoder3• 1 month ago

The HB vaccine unfortunately doesn't work that well, many people are still not fully immune even after several doses

This is incorrect. The HBV vaccine is one of the most effective vaccines available for any pathogen, providing full immunity to over 95% of healthy infants, children, and young adults, and with that immunity typical lasting for at least 30 years (and likely for life).

If someone is one of the rare exception, tthat's easy to detect with blood titers, and the response is either to give them additional doses or to deliver an adjuvanted version (which is the same thing regularly done for other vaccines which are either less effective or primarily targeted at the elderly, who have weaker immune responses).

GreenSalem• 1 month ago

Indian pharmaceutical companies will produce a biosimilar in months.

This will enable it to be supplied at a non-exploitative price to Africa and Asia.

Zenst• 1 month ago

They produce drugs whose patents have expired; drugs still under patent are something they mostly avoid. The term for 3rd party versions of these drugs are often referred to as `generics`, which sees the same drug, but a different name(names also have copyrights that seem to extend longer).

However, if they can tweak the drug and make it something that escapes the patent and still works then good for them and everyone else. Though mindful large pharma is rather tight and lawyer-heavy when it comes to protecting their IP.

As of now it is under patent that expires in 2032, and also not FDA approved, so with how long that process takes, either way, wont see it available anytime soon in drug regulated countries. But grey imports/black market trade in pharma drugs is not to be overlooked.

singpolyma3• 1 month ago

names also have copyrights

Probably you're thinking of trademark. A name cannot have a copyright

philipallstar• 1 month ago

This will enable it to be supplied at a non-exploitative price to Africa and Asia.

It's millions of times easier to copy than to discover. Discovery needs paying for, and the places that don't discover aren't owed things by places that do.

shevy-java2• 1 month ago

“functionally cured” 19% of people naturally control that virus without any further treatments

So in other words: a very minor result.

19% is not a lot.

And the term "functionally cured" when they still have the virus, is not a cure, by definition. I get that for many this may be an improvement, but my gripe is with the wording here. This is inflation of feel-goodness.

TheAceOfHearts• 1 month ago

It helps to look at some figures to bring it into perspective instead of making off hand comments about how it's not a lot. Remember these are human lives!

After some searching, I found estimates ranging between 600 thousand to 1.6 million people living with Hepatitis B in the US.

If we can help 20% of those people, that means significant life improvements to somewhere between 120 thousand and 320 thousand people.

If we take the upper end, that's half the population of Wyoming.

2muchcoffeeman• 1 month ago

Yes! Always run some numbers in your head. People will sometimes pick percentages or numbers in an attempt to bolster their arguments. Don’t buy it, work it out for yourself.

mlyle• 1 month ago

It is also worth noting that others were helped, too, just not to the extraordinary level of a functional cure.

energy123• 1 month ago

19% vs 15% would be "not a lot". But this is 19% vs 0%!

Quote: "233 of 1220 people who had received bepi had functional cures—both undetectable HBV DNA and surface antigen—versus zero of 614 participants in the placebo arm."

This is a HUGE deal because low virality now doesn't mean low virality in the future.

hereme888• 1 month ago

"Like the nukes, bepi doesn’t eliminate the embedded cccDNA..."

That's the ugly part about these rt-DNA viruses. They embed into your own DNA, causing issues for life.

New drug 'functionally cures' many hepatitis B virus infections

Related Stories