I sense the urgency and anxiety in your question but unfortunately, there’s currently no cure for Hepatitis B. Pre-clinical models are typically mouse models, even the study you reference (Ebert, Gregor, et al. “Eliminating hepatitis B by antagonizing cellular inhibitors of apoptosis.” Proceedings of the National Academy of Sciences112.18 (2015): 5803-5808.). Results from such models typically take years to translate to humans. In fact, more often such pre-clinical data progress no further because they fail in higher animals or humans.
In the case of Hepatitis B virus (HBV), there’s currently no cure, only treatment to control virus (remission) and prevent irreversible liver damage. Hepatitis B Rx (treatment) is complex, dynamic and critically based on periodically scheduled tests for
- Presence and amount of circulating HBV DNA and antigen levels.
- Assessment of liver function.
Regular blood tests monitor for
- Presence of Hepatitis B virus (HBV) antigens and DNA.
- Antigens include HBsAg (quantitative surface Hepatitis B surface antigen) and HBeAg (Hepatitis e antigen).
- Assessment of liver function by assessing levels of serum alanine aminotrasferase (ALT), logic being healthy liver = low levels of serum ALT.
- Risk for developing HCC (Hepatocellular carcinoma), usually by measuring blood levels of AFP (alpha-fetoprotein) and an ultrasonograph every 6 months.
- If patient >40 years of age, liver biopsy to assess inflammation and fibrosis.
- Results of these tests are then used to determine best course of action w.r.t. Rx.
- Typically Rx is several months-long to even life-long.
Physicians treating patients for HBV should follow Rx guidelines set forward by regional Associations for the Study of the Liver. For example, the American (AASLD), European (EASL) and Asian-Pacific (APASL) Associations for the Study of the Liver published their guidelines for Hepatitis B Rx in 2009, 2012, and 2012, respectively. At the least, I hope this answer helps you understand whether your mother’s treating physician(s) are following the latest published consensus HBV Rx guidelines of experts in the field.
This answer relies on the 2012 Asia-Pacific guidelines published here: Liaw, Yun-Fan, et al. “Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update.” Hepatology international 6.3 (2012): 531-561.
First, a glossary of terms to help understand key terms used to denote HBV disease features and Rx outcomes.
Next, most recent (2012) Rx available in Asia-Pacific. According to Liaw et al, these include interferon-alpha (IFN-a), pegylated IFN (Peg-IFN)-a2a and a variety of nucleos(t)ide analogs such as lamivudine (LAM), adefovir (ADE), entecavir (ETV), telbivudine (TEL), tenofovir (TDF). They also note ‘Peg-IFNa2b has been approved for the treatment of chronic HBV infection in a few countries. Thymosin-a1 has also been approved in some countries in Asia. Clevudine has been approved only in Korea and the Philippines‘. However, IFN-alpha Rx has several side-effects which include flu-like symptoms, headache, fatigue, muscle pain, hair loss. So IFN-alpha Rx is usually of fixed duration followed by 6 to 12 months of observation.
Liaw et al summarize their chronic HBV Rx recommendations in the following self-explanatory figures.
Key item to note from their figures is decision to start Rx is based on circulating HBV DNA and ALT levels. They recommend that Rx should start if person has persistently elevated serum alanine aminotransferase (ALT) levels that are at least 2 times higher than the upper limit of laboratory reference (ULN), provided the two tests for serum ALT levels were done at least 1 month apart. HBV patients diagnosed with liver cirrhosis have a specific Rx plan.
While Rx is available for controlling HBV, eradication is rare. Thus, compliance of patient in regularly taking the drugs, availability and cost of the drugs, and potential side-effects are all critical issues for patients and caregivers.