Hep B Blog

HBV Journal Review – February 2014

ChrisKHBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • Tests for Antigens and Drug-Resistant Virus Emerge as Valuable Diagnostic Tools
  • Experts Issue a Report Card on Side Effects from Antivirals
  • Experts Weigh in on Why They Prefer Either Antivirals or Interferon
  • Doctors Explain Which Medical Guidelines They Follow, Or Ignore
  • Truvada Effective in Lowering Viral Load in Young Adults with High Viral Load
  • Hepatitis B Causes Most Liver Cancer Deaths in China
  • Smoking Shortens Survival after Liver Cancer Surgery

 HBV Journal Review

February 1, 2014
Vol 11, no 2
by Christine M. Kukka

Tests for Antigens and Drug-Resistant Virus Emerge as Valuable Diagnostic Tools

Measuring the amount of hepatitis B surface antigen (HBsAg) in your bloodstream or conducting quick tests for drug-resistant hepatitis B virus (HBV) may soon be part of your office visit in the brave new molecular world of hepatitis B treatment.

Doctors increasingly are measuring HBsAg levels to determine if treatment is needed or if current medications are working. HBsAg tests—along with measuring alanine aminotransferase (ALT) for signs of liver damage and HBV DNA for viral load—may become essential tools to assess hepatitis B progression or remission.

HBsAg is the protein that makes up the outer covering of HBV. When a patient has a high viral load (and is positive for the hepatitis B “e” antigen—HBeAg), there are often large quantities of HBsAg circulating in the blood stream. When viral replication slows and HBeAg disappears, there can be lower quantities of HBsAg.

But experts are learning that high HBsAg levels can increase cancer risk, even in HBeAg-negative patients, according to a study published in the journal Annales de Biologie Clinique. (1) As a result, there is heightened attention on HBsAg as a key indicator of a patient’s health. For example:

  • In HBeAg-negative patients, HBsAg levels less than 1,000 international units per milliliter (IU/mL) along with low viral load (HBV DNA) under 2,000 IU/mL indicate the patient is an “inactive” patient.
  • When patients are treated with pegylated interferon, doctors can tell if the treatment is working if there is a decline in HBsAg levels within 12 weeks. This early indicator can save money if the drug isn’t working and help to avoid uncomfortable side effects. Doctors recommend patients with genotypes B and C should stop interferon at week 12 if their HBsAg levels remain at 20,000 UI/mL or higher.

Another team of French researchers, also exploring the implications of HBsAg in an article published in the February 2014 issue of the journal Liver International, suggest that as HBsAg levels decline, so does the risk of liver cancer.

They also suggest that during antiviral treatment, a rapid decline in HBsAg may indicate which patients will eventually clear HBsAg. A 100-fold decline or more of HBsAg over six months of treatment, “… could be a marker of a sustained response after treatment cessation,” they wrote.(2)

In another diagnostic breakthrough, researchers writing in the December journal of Clinical Molecular Hepatology promoted the value of a HepB Typer-Entecavir kit that can precisely detect HBV that have viral mutations that can “resist” the antiviral drug entecavir (Baraclude). This diagnostic tool allows doctors to select the most effective antiviral for each individual patient based on the molecular makeup of their HBV.(3)

1. Source: www.ncbi.nlm.nih.gov/pubmed/24235324  
2. Source: www.ncbi.nlm.nih.gov/pubmed/24373085  
3. Source: www.ncbi.nlm.nih.gov/pubmed/24459645

Experts Issue a Report Card on Side Effects from Antivirals
Hong Kong researchers evaluated the side effects of commonly-used antivirals in the December 2013 issue of the Journal of Gastroenterology and Hepatology. Antivirals disrupt the genetic make-up of HBV, making it difficult for the virus to replicate. While generally safe, patients must take antiviral pills daily over several years and side effects include damage to the mitochondria of the body’s cells (called mitochondria toxicity.)

Continue reading this and additional studies for Februrary

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2 thoughts on “HBV Journal Review – February 2014”

  1. Hello I am 26 year old male,
    1 year ago I tested hbsag postive, hbeag positive, antihbe negative and anti hbs negative and a viral load of 20Million IU/ml.

    I have started peginterferon therapy 20 weeks ago. At week 12 I had same results of serology no improvements and a viral load of 3.5 Million. According to this article I should stop taking peginterferon. What’s the next step then? Should I switch to viread or some other medication?

    Doctors here where I live (south eastern erope) are really shi**y (sorry my words) they told me I should go on with the treatment, their examinations are very short without paying too much attention to my specific case. I am feeling that I should find a better doctor but no success so far. Do you have any suggestions for someone/web who gives medical advices online(paid service) since I am unable to travel and seek a better doctor for now.

    1. Hello: Medical guidelines in the U.S. recommend treatment only if you have signs of liver damage (elevated liver enzymes – called ALT or SGPT) AND a high viral load. As you know you have a very high viral load and are clearly in the “immune tolerant” phase of hepatitis B and are still HBeAg-positive. If your ALT/SGPT levels are around 30 or under, you would not be recommended for treatment under the current guidelines. If you did need treatment, pegylated interferon might be the better choice, because it boosts your immune system to help it fight the infection. The trouble is, interferon doesn’t work unless you already have elevated liver enzymes, indicating your immune system is targeting and attacking your infected liver cells.
      If your ALT levels are normal, and if interferon hasn’t worked, you may want to talk to your doctor and suspend treatment and continue frequent monitoring. The World Health Organization has published hepatitis B treatment guidelines at: http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/, which you may want to review with your doctor. The European Assoc. for the Study of Liver Disease hepatitis B guidelines are at: http://www.easl.eu/research/our-contributions/clinical-practice-guidelines/detail/management-of-chronic-hepatitis-b-virus-infection
      Generally, doctors don’t want to start young adults on antiviral treatment unless there is liver damage. Daily antiviral pills work to suppress viral replication — but only for as long as you take them. No one wants you to start treatment and continue for decades, or stop treatment and experience a dangerous reactivation. That is why doctors are cautious with people in your stage.
      You probably already know this, but with your high viral load your blood and body fluids (semen) are extremely infectious, so remember to practice safe sex, bandage any cuts or bruises, and do not share toothbrushes, personal jewelry or nail clippers. And of course, avoid alcohol and cigarettes and eat healthy food. Good luck.

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