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.
It's estimated that 300 million people have HBV. HBV is currently incurable once acquired. 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.
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 suporessable through antiviral treatment, making it generally untransmittable (if treated and suppressed) and unlikely to cause symptoms.
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 and if it causes cirrhosis, approximately one third of people clear HCV infection in the acute stages, and 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)
> 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".
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?
Pretty sure the cover image is a Strokes album cover.
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.
It's estimated that 300 million people have HBV. HBV is currently incurable once acquired. 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.
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 suporessable through antiviral treatment, making it generally untransmittable (if treated and suppressed) and unlikely to cause symptoms.
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 and if it causes cirrhosis, approximately one third of people clear HCV infection in the acute stages, and 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)
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.
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?
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.
> 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?