New drug 'functionally cures' many hepatitis B virus infections
science.orgIndian pharmaceutical companies will produce a biosimilar in months.
This will enable it to be supplied at a non-exploitative price to Africa and Asia.
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)
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.
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.
Nope - because it can not target the genome. So it is, by definition, not a permanent reduction. Any inhibitor is a protein; unless such a protein modifies the DNA, one only cures a symptom, not the cause, by definition. HAART with regards to the HI virus has a similar problem.
Note that even on commercial sites they point this out:
https://www.medchemexpress.com/im-250.html
"Adibelivir (IM-250) is an orally active helicase-primase inhibitor. Adibelivir is effective against HSV infection and reduces reactivation of latent HSV."
See the word "reduces". Nowhere does it insinuate "permanently"; besides, permanently is simply a misnomer here. Even "latent" is a misnomer; it simply is integrated DNA. The only way to get rid of it is to cut this DNA out. Which therapeutic does so with efficiency? Even CRISPR-Cas9 has off-target effects. There are no permanent cures, and insinuating otherwise by using "permanently", is simply and factually incorrect.
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.
> 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.
They didn't give it to males, and didn't let males get it, until recently.
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.
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.
Australia has been giving it to everyone for quite a while now. Last I saw, the virus is almost completely eradicated.
Aren't you confusing with HSV ?
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.
https://pubmed.ncbi.nlm.nih.gov/39956964/
Link between HSV and dementia
Yep — if this is properly verified it means HSV is one of the most consequential virus families in public health.
For the same reason we should be hoping for a treatment that can rid the body of VZV (chickenpox/shingles) because it is absolutely clear that the shingles vaccine has some protective effect against dementia.
...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).
Yeah HSV on its own would be awesome to find a good vaccine for but the insights it would give for vaccinations against the broader human herpes virus family would be massively impactful.
A successful HSV vaccine would also almost certainly lead to a vaccine for epstein-barr, cytomegalovirus, and roseolovirus.
Even ignoring the thousands of connections HSV is suspected to have to other diseases, getting insight towards the other 3 big "uncured" HHVs would be a massive deal.
EBV/mono is a silent but debilitating disease that infects a near majority of the population even in "developed countries" and is all but confirmed as a requirement for developing multiple sclerosis. EBV is also directly connected to a long list of cancers as well.
cytomegalovirus and roseolovirus while less common in the developed world are still far too common and globally are major sources of harm for infants and young children.
Any steps towards effective vaccination against the broader family of HHVs would be monumental.
> “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.
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.
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.
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.
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?
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.
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.
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.
It's not really the same thing. If we exclusively tested coronavirus with PCR tests it'd be a lot more similar but the presence of kit tests and "30 minute covid testing" really muddied the water.
And of course Covid tests are primarily mucous membrane based which is going to be inherently harder to evenly test compared to a blood sample where viral load is pretty evenly distributed.
At least for blood based diseases, detecting viral load via PCR testing is to such a sensitivity that if there's essentially any active viruses out and about or any active viral RNA floating around in cells then the tests come back positive.
And with sustained antiviral use testing is less about "do I have it/will I become contagious in the near future" (like coronavirus) and rather "is my antiviral regimen still killing the virus faster than it can wake up from latent genetic material sleeping in DNA".
The former is a timing problem from one shot testing the latter is monitoring a steady state to track that the treatment remains effective and when it ceases being effective there's a lag time between viral load being detectable and sufficient viral load to be meaningfully contagious.
> 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".
Isn't half the selling point of antiretroviral therapy that you're no longer contagious?
https://i-base.info/u-equals-u/
U=U probably does not apply to all diseases for the reasons you mentioned though.
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.
The trial enrolled non-cirrhotic patients with moderate baseline HBsAg (100 to 3,000 IU/mL) already on stable nucleotide analogue therapy. That selection matters because HBV-related deaths are driven almost entirely by cirrhosis and hepatocellular carcinoma, and those outcomes cluster in patients with higher antigen loads and advanced disease. The 19% result is real and independently replicated in over 1,800 patients, but whether bepirovirsen reduces the 1.1 million HBV deaths per year depends on trials in populations that weren't enrolled here.
> The 19% result is real and independently replicated in over 1,800 patients, but whether bepirovirsen reduces the 1.1 million HBV deaths per year depends on trials in populations that weren't enrolled here.
Do we know, how many of those deaths are due to limitations of existing treatments, versus how many are due to health care access issues?
This comment smells like Claude.
Agreed.
>AI Engineer @Varnan Labs
Bingo. A glance at their comment history shows this is a pattern for them
Pretty sure the cover image is a Strokes album cover.
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.