Its Great Weve Got But Its Not Where We Need To Be He Says One Class Is Hard To Take The Other You Need To Take Forever
HBVs assault on the liver causes a disease called Hepatitis B . Most adults with hepB recover within one to three months after symptoms start, but when the infection persists longer than six months its considered chronic. As the virus attacks the liver cells, it leaves behind nasty scars called fibrosis. In up to one-third of the patients the scars become severe , eventually resulting in liver failure or liver cancer. While hepB can be fatal, it is treatable, but it is also easily prevented to a degree of 95% through routine, safe, immunisation.
Upscaling vaccination, screening and treatment is the best way to keep this viral criminal at bay. New developments or scientific breakthroughs in any of these three areas is bad news for HBV, but good news for us. So, when scientists on the frontline say this deadly disease is about to meet its match, its great news.
B Cells In The Natural History Of Disease
Anti-HBV antibodies are used as biomarkers for resolution of HBV infection but the immunological impact of B cells and antibodies on the natural history and resolution of chronic HBV infection, or on seroconversion in chronic HBV infection, have been under-investigated.112 B cells can produce the immune-suppressive cytokine interleukin-10 but their depletion can also result in clinical reactivation in both patients with resolved infection and those with chronic hepatitis B.107,113,114 Therefore, fundamental questions related to B-cell biology, antibody specificity, and neutralising responses need to be addressed so that B cells can be incorporated more effectively into new immunotherapeutic approaches.
Assays and reagents need to be developed and optimised for the detection and quantification of HBV-specific B cells. ELISPOT assays are needed for accurate and reproducible quantification of B cells producing HBV-specific antibodies for research and clinical trial monitoring. Flow cytometry-based reagents are needed to investigate the phenotypic, functional, and genetic profile of HBV-specific B cells. Deeper analysis of antibody specificity, isotype, and functional responses in different stages of HBV infection should be a key area of future research.
Is Hepatitis B Preventable
Chronic hepatitis B infection affects at least 250 million people worldwide, causing over 880,000 deaths annually. It is also the major cause of liver cancer, the second leading cause of cancer-related deaths in the United States.
Unlike its cousin hepatitis C, hepatitis B can be prevented with vaccines. If you are accidentally exposed to the virus, there are also drug therapies you can takeâcalled postexposure prophylaxisâto avert the infection.
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How Far Have We Got
Some exciting research is underway around the world, including the recent identification of the cell receptor which allows the virus to infect the body. This has enabled studies of the complete virus replication cycle including the viral reservoir that is untouched by current therapies.
New approaches to a possible cure include mechanisms to block the virus entry into the cell and to stop the virus from making the proteins it needs to replicate and infect new cells.
Studies are also underway to enhance patients immune responses so their own natural defences can control or even eliminate the virus. This is similar to immunotherapies already being used to treat some cancers.
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Its likely a hepatitis B cure will require a dual-pronged approach, directly targeting the virus while also enhancing the immune response in people who are infected.
The goal is to reduce the amount of virus in the body and restore the persons immune responses. This is called a functional cure and is similar to what happens when a person naturally gets rid of the virus. It would also mean they didnt need to take drugs any more.
Some of these approaches are now in early stage human clinical trials. More than 30 drugs have been developed and are being tested in people with chronic hepatitis B. However, much more work needs to be done to achieve a cure.
Treatment Options For Hepatitis B
People living with chronic hepatitis B infection should expect to live a long and healthy life. There are decisions people can make to protect their livers such as seeing a liver specialist or health care provider regularly, avoiding alcohol and tobacco, and eating healthy foods. There are also approved drugs for both adults and children that control the hepatitis B virus, which helps reduce the risk of developing more serious liver disease, but there is still no complete cure.
Current treatments for hepatitis B fall into two general categories:
- Immune modulator Drugs These are interferon-type drugs that boost the immune system to help get rid of the hepatitis B virus. They are given as a shot over 6 months to 1 year.
- Antiviral Drugs These are drugs that stop or slow down the hepatitis B virus from reproducing, which reduces the inflammation and damage of your liver. These are taken as a pill once a day for at least 1 year and usually longer.
It is important to know that not everyone with chronic hepatitis B infection needs to be treated. This can be difficult to accept when first diagnosed because taking a drug to get rid of the virus seems like the first step to getting better. Current treatments, however, are generally found to be most effective in those who show signs of active liver disease .
Hepatitis B Drug Watch
Visit the HBF Drug Watch for a complete list of the approved treatments for hepatitis B and promising new drugs in development.
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Coordinated Clinical Studies To Advance Hbv Cure
While the pharmaceutical industry will develop novel drugs and evaluate them in clinical trials, collaborations with clinical scientists outside of industry will be instrumental to the success of drug development, by facilitating clinical studies, characterising correlates of cure, refining treatment endpoints, and identifying the best patients for clinical trials according to the mode of action of the tested drugs.
The timing for initiation of curative regimens will also require careful consideration. There is emerging evidence that the HBV disease time-clock commences ticking earlier than previously appreciated. This is demonstrated by the finding of integrated HBV DNA in infected hepatocytes within a few days of viral infection in vitro123 and in patients during the so-called immune tolerant stage of HBV natural history.115 There is also increasing evidence that HBV DNA integrations are associated with liver cancer,124 and it remains to be determined whether early initiation of treatment would reduce the likelihood of progression to hepatocellular carcinoma by preventing integration, inflammation, and cell turnover, and in turn clonal expansion of hepatocytes harbouring integrated sequences.
Is There A Cure For Chronic Hepatitis B
Currently, there is no complete cure for hepatitis B. But when managed properly, those living with the virus can expect to live a normal life. Maintaining a healthy diet and avoiding alcoholic beverages and tobacco products are crucial components in managing the disease.
You should also visit a doctor familiar with hepatitis B at least annuallythough twice a year might be best to monitor your liver through blood tests and medical imaging. As with most diseases, detecting it early leads to a better outcome. If youre exposed to the virus, you should get an antibody injection within 12 hours of exposure.
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Strategy : Curing Hbv Infection Without Killing Infected Cells
More than 50 years have elapsed since the discovery of HBsAg.41 The discovery of the HBV entry receptor NTCP in 20128 revolutionised our ability to study in vitro the HBV replication cycle from infection to egress, and the development of new animal models that permit studies of immunopathogenesis4244 and preclinical antiviral evaluation. However, these models still have considerable limitations, and important gaps in our understanding of the HBV replication cycle and the host immune response must be addressed to expand the exploitable vulnerabilities in the replication cycle that can be targeted therapeutically to cure the infection.
Great Progress Has Been Made In Treating The Virus Though More Can Be Done
There is currently no cure for people living with chronic hepatitis B virus infection. Those unable to naturally fight off the virus may live with it for many years without experiencing any symptoms until the liver becomes damaged. Because of this, people diagnosed with chronic hepatitis B virus infection need to be regularly tested and monitored to watch out for liver damage.
Additionally, we recognise that people living with chronic hepatitis B virus infection may also endure significant psychological pain and social stigma. Although most transmission occurs from mother to child during birth, there are other routes of transmission which can cause people to view their condition as something shameful, potentially reducing their likelihood to seek care and their quality of life.
Current hepatitis B treatments work to suppress the activity of the virus, keeping it inactive with antiviral therapies. These treatments can help protect the liver but rarely clear the virus completely. This means many people with hepatitis B require treatment for the rest of their lives.
Scientists are now looking to go one step further by switching the focus to the virus RNA. They have discovered that interfering with the RNA not only stops viral replication but also halts the production of viral proteins and allows for an opportunity to investigate whether this can stop hepatitis B in its tracks.
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What Is Involved In A Liver Transplant
A liver transplant is considered necessary when the liver is damaged and cannot function or in some cases of liver cancer. Your liver is very important. It is responsible for many functions related to making sure that your body stays healthy and is able to digest foods.
You may be eligible for a transplant if you have chronic hepatitis B infection or some of the diseases that may result from it, including liver cancer and cirrhosis. You will have to complete testing and be evaluated before being approved for a transplant. It is likely that you will be placed on a waiting list while an appropriate organ is found.
Donated livers come from two types of donors: living and deceased. Because the liver can regenerate, it is possible to use part of a liver for transplant. The remaining sections in both the donor and the receiver will grow into livers of adequate size.
People who get liver transplants must take anti-rejection drugs for the rest of their lives. These drugs make you more susceptible to infection. However, liver transplants have become more successful over time and continue to improve.
Prognosis Improvement After Hbsag Clearance
These related studies provide clear recommendations that patients who achieve HBsAg clearance have favourable clinical outcomes compared to patients who achieve only HBV DNA suppression and HBeAg seroconversion. HBsAg clearance leads to biochemical, virological and liver histological improvements, and it significantly reduces the risk of HCC. However, HCC may occur after HBsAg seroclearance despite it being the ultimate treatment endpoint recommended by current guidelines. The risk factors associated with HCC include the presence of cirrhosis, male sex, and age50 years at the time of HBsAg clearance . Closer attention should be given to patients with one or more of these risk factors.
These high-risk patients should be re-examined in a timely manner even if HBsAg clearance is obtained. These results also suggest that achieving a functional cure early in the absence of cirrhosis results in a better prognosis .
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Is There A Cure For Hepatitis B
The long and short answer is that there is not yet a cure for hepatitis B. Understanding why requires insight into the virus itself and the challenges cure researchers face.
Hepatitis B is an infectious disease caused by the hepatitis B virus . While most people exposed to hepatitis B will spontaneously clear the virus soon after infection, a proportion will go on to develop a chronic infection.
Of these, around one in four will develop severe liver complications, including cirrhosis and liver cancer, typically years after the initial infection.
Efforts to find a cure for hepatitis B have been underway since the virus was first identified by scientists at the National Institutes of Health in 1966. It soon became clear, however, that numerous hurdles would need to be overcome before an actual cure could be achieved. Chief among these are:
How Is It Currently Treated
There is no cure for chronic hepatitis B virus.
In most cases, treatment requires taking a pill every day for life to remain effective and to reduce the risk of liver cancer. Even then, it doesnt eliminate the risk.
Chronic hepatitis B hasnt been cured so far in part because current therapies have failed to destroy the viral reservoir, where the virus hides in the cell.
This is in contrast to hepatitis C virus, which has no such viral reservoir and can now be cured with as little as 12 weeks of treatment.
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Despite the huge human and economic toll of chronic hepatitis B, research to cure the disease remains underfunded. There is a misconception that because there is a vaccine, hepatitis B is no longer a problem.
The availability of effective cures for the unrelated hepatitis C virus has also led people to believe that viral hepatitis is no longer a problem.
Experts estimate that liver cancer deaths will substantially increase in coming decades without a cure for hepatitis B, despite deaths from most cancers decreasing.
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Clearing Acute Hepatitis B
Some studies suggest that up to 95% of adults with acute HBV infection will spontaneously clear the virus, usually within six months, with no lasting repercussions.
Chronic hepatitis B occurs when the immune system does not clear the virus. Around one of every 20 people acutely infected with HBV will progress to this persistent stage of infection.
Chronic hepatitis B is a slowly progressive disease in which ongoing inflammation causes the gradual scarring of the liver. This can lead to cirrhosis and hepatocellular carcinoma .
However, the course of chronic HBV infection is not set. Some people may progress faster than others, while others may never develop overt symptoms.
Statistically speaking:
- The risk of cirrhosis in people with chronic hepatitis B is approximately 10% to 20% over 20 years, increasing to 40% after 30 years.
- The risk of hepatocellular carcinoma increases by 2% and 3% per year in people with HBV and cirrhosis. People without cirrhosis can also get it, but the annual risk drops to around 0.02%.
Nature Reviews Commentary Lays Groundwork For The Momentum Behind Hepatitis B Cure Research And The Long
On the eve of World Hepatitis Day, the International Coalition to Eliminate HBV , a global group of researchers, patient representatives and health organisations, has called for the integration of a hepatitis B cure in global plans to eliminate viral hepatitis.
More than 290 million people worldwide are chronically infected with the HBV, a viral infection that attacks the liver and can cause both acute and chronic disease. Last year, nearly 900 000 people died from the disease.
A safe and effective vaccine to prevent HBV infection has been available since 1982 and its universal delivery is essential for the elimination of HBV as a public health threat. Lifelong treatment is also needed for those already chronically infected but currently is only accessed by some five per cent of the people who need it.
Some 900 000 people dying unnecessarily of hepatitis B every year is completely unacceptable, said Associate Professor Peter Revill, ICE-HBV Chair and Senior Medical Scientist in the Royal Melbourne Hospitals Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity .
HBV cure research could make all the difference and prevent adverse outcomes in all people infected with HBV, allowing them to live treatment-free, fully productive lives and reduce the stigma associated with this chronic infection.
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Can Hepatitis B Spread Through Contaminated Water
Breastfeeding, sharing eating utensils, hugging, kissing, holding hands, coughing, and sneezing are all examples of ways to contract hepatitis B. In contrast to some types of hepatitis, the virus is not spread through contaminated food or water.
Hepatitis B: Avoiding Infection
Although these precautions are taken, there is still a chance that you will catch hepatitis B from a person who has the virus. To avoid contracting hepatitis B, avoid contact with people who are infected. If you become infected, protect yourself from spread by washing your hands frequently and avoiding contact with blood and body fluids.
Whats The Prognosis For Hepatitis B
Your doctor will know youâve recovered when you no longer have symptoms and blood tests show:
- Your liver is working normally.
- You have hepatitis B surface antibody.
But some people don’t get rid of the infection. If you have it for more than 6 months, youâre whatâs called a carrier, even if you donât have symptoms. This means you can give the disease to someone else through:
- Unprotected sex
- Contact with your blood or an open sore
- Sharing needles or syringes
Doctors donât know why, but the disease does go away in a small number of carriers. For others, it becomes whatâs known as chronic. That means you have an ongoing liver infection. It can lead to cirrhosis, or hardening of the organ. It scars over and stops working. Some people also get liver cancer.
If youâre a carrier or are infected with hepatitis B, donât donate blood, plasma, body organs, tissue, or sperm. Tell anyone you could infect — whether itâs a sex partner, your doctor, or your dentist — that you have it.
Show Sources
CDC: âHepatitis B Questions and Answers for Health Professionals,â âHepatitis B Questions and Answers for the Public.â
Mayo Clinic: âHepatitis B.â
UpToDate: âHepatitis B virus: Screening and diagnosis.â
CDC.
HealthyPeople.gov: âHepatitis B in Pregnant Women: Screening.â
Annals of Internal Medicine: âScreening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: U.S. Preventive Services Task Force Recommendation Statement.â
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