HBIG to lower hbsag and rescue tcells

[stef2011]

my hbsag is constantly lowering, early this year 850iu/ml, once it reaches values less than 400iu/ml
i am planning to use HBIG 1000iu to lower it and increase my immune response faster.i will keep using gcmaf and tdf as i am doing now
there are very few studies on this, mainly before/after liver transplant to clear hbsag, please post here any study if you  find any.
nivolumab one single low dose would be a nice add on but i prefer stay safe due to my thyroid damage after pegintf, now i am fine without any thyroid medication and tsh around normal, ft4/ft3 normal, so it is probable i ll never use this.i might use isoprinosine instead

there is one study using HBIG to increase immune response before starting pegintf, unfortunately this will end in 2022

this is useless on patients without any immune response and any hbsag lowering by themselves but in my case with the use of immune modulators like  isoprinosine it might do something and nothing to lose as side effects

[needadvicewithhep]

Hi Stef Thats good news :) I'm happy for you

HBIG is used mainly in acute cases no?  Isn't a bit hard side effects  like Peg?

If its reducing at that rate wouldn't it be worth considering staying with TDF and gcmaf within a couple of years it could clear no?

[stef2011]

i didn t try it yet i'm still waiting to reach very low hbsag levels.last time i checked it was arounf 850iu/ml, still too high to try Hbig

[stef2011]

and yes i m still on tdf and gcmaf because hbsag is not lowering.i think one of my antiage protocols might have fasten decline, it could be senescent cells clearance but i cannot retry that now to see if it makes hbsag decline

[hepbresearch]

Thank you.  You have any update on your situation?
Also - what if the lowering of SAg is happening because of medication and not necessarily because of one’s own immunity?  

[needadvicewithhep]

Interesting. Study be interesting to see how it goes.

Glad to hear your well Stef

[Jatashankar]

Will HBSAG loss be sustainable?

[stef2011]

it is just an experiment but the patients in this trial had no side effects.those with very low hbsag like 20iu/ml had it clear definitively those with higher hbsag (but les than 500iu/ml no)

[Jatashankar]

What cud be the complications?

[Jatashankar]

How many vials of 100iu hbig will be needed to eliminate HBSAG in hep negative patient with about 2500-8000iu HBSAG load? What will be the frequency of dose? Will it be effective on longer use? Hbig in India is not that expensive, it costs ₹4000-5000/vial.

[stef2011]

that hbsag is too high.there s possible renal toxicity when hbsag is very high, see the full study

[Jatashankar]

How likely is that HBSAG rebound may occur after hbig use? Why not hbeag individuals use tdf or taf along with inosine(isoprinosine) and expect resolution.
Y inosine is not available in indian market?
Can inosine not disturb autoregulation and lead to autoimmunity?

[Jatashankar]

How likely is that HBSAG rebound may occur after hbig use? Why not hbeag individuals use tdf or taf along with inosine(isoprinosine) and expect resolution.
Y inosine is not available in indian market?
Can inosine not disturb autoregulation and lead to autoimmunity?

[joc2011]

I will like to try this. Where is the easiest place to buy this?

[stef2011]

HBIG  is extremely expensive, at least in the western countries.it is available in the pharmacies, it is mainly used in case of possible hbv transmission before a vaccine works and before liver transplnt to make hbsag negative after transplant
what is your hbsag level?

[stef2011]

i saw a study on liver transplant and baseline hbsag was very high like 2500iu/ml, they used very high hbig and hbsag decresed to 167iu/ml.i can t find it but i m going to recheck on browser history.my guess is a potent immune modulator might work better if started at that low hbsag level like nivolumab or pegintf

[joc2011]

My HBSAG is currrently around 1900 iu/ml

[stef2011]

1900iu/ml is too high to try this, as soon as you stop it will relapse if it ever lowers on hbig low doses like 1000iu.it is best to wait until it reaches very low values

[joc2011]

Ok. Thanks. Will wait

[Jatashankar]

I am not aware of 1000iu is a low dose coz vials come in 100iu and 200iu only.

[stef2011]

oh i didn t know, the one i have are 1000iu

[stef2011]

hbsag levels baseline too low to give an idea about what happens at 400-500iu/ml and only genotype C patients...anyway trials with more patients, little higher hbsag baseline, more potent nucs like tdf and higher/longer doses of HBIG are needed.this means we can experiment ourselves as lon g as creatinine is monitored and HBIG is not too high, 1000-2000iu hbig should be safe.one thing is for sure, this is totally useless for hbsag levels above 500iu/ml

[mike9111]

Goof news Stef2011 and long time no talk. Maybe that will help me as my latest hbsag quant came back yesterday at 3.80 iu/ml

[stef2011]

wow i found a study that used my same idea: full study on this link
https://www.researchgate.net/publication/297606873_Antiviral_effects_of_anti-HBs_immunoglobulin_and_vaccine_on_HBs_antigen_seroclearance_for_chronic_hepatitis_B_infection

abstract
Antiviral effects of anti-HBs immunoglobulin and vaccine on HBs antigen seroclearance for chronic hepatitis B infection

Background and aims: Interferon and nucleotide/nucleoside analogues are the main treatments for chronic hepatitis B. These drugs effectively reduce serum hepatitis B virus (HBV) DNA titers but fail to sufficiently reduce hepatitis B surface antigen (HBsAg) levels. Following the recent identification of sodium taurocholate cotransporting polypeptide as a receptor for HBV entry, inhibition of HBV entry has become an attractive therapeutic target for chronic hepatitis B treatment. We therefore evaluated the antiviral effects of antibody to HBsAg (anti-HBs) immunoglobulin (HBIG), which can inhibit HBV entry, by in an vivo study and a clinical trial. Methods: In the in vivo study, HBV-infected mice were generated from human hepatocyte chimeric mice and treated with HBIG. A clinical trial evaluating HBIG therapy in patients was also performed. Results: In the mouse study, HBV DNA titers were reduced and serum HBsAg titers decreased to undetectable levels following high-dose HBIG injection. On the basis of this result, eight chronic hepatitis B patients, who had received long-term nucleotide analogue treatment, were treated with monthly HBIG injections as an additional treatment. After 1 year of treatment, an HBsAg level reduction of more than 1 log IU/mL was observed in four patients, and three patients became anti-HBs positive. No adverse events occurred during HBIG therapy. Conclusion: These results suggest that monthly HBIG injection might benefit patients with chronic hepatitis B whose HBsAg titer becomes lower following long-term nucleotide/nucleoside analogue treatment.

[samir1978]

Hi Stef , my hbsag is now 3.85iu/ml , my dna is 63iu/ml

I’m seriously considering taking HBIG , do you recommend a specific dose ?

I’m also taking vitd but have not tested yet. Any other supporting medications?

I have never been on any sort of hb medications , my readings were always similar to the above figures.

Many thanks

[stef2011]

in the study they used 1000iu of hbsag monthly but you may take higher doses if you can afford it.my relative uses 1000iu every 10 days for prevention of reinfection it all depends on hbsag/hbsab response