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.
IM-250 (Adibelivir) is a helicase-primase inhibitor that targets latent HSV so well it may actually permanently reduce the pool of viable latent HSV genomes.
> Yes, there is an effective vaccine but not everyone has access to it for tons of reasons.
Also, about 3.5% of the world's population already has it. That's about 300 million people for whom a vaccine is pointless, and who are at dramatically higher risk of liver cancer (somewhere between 15-50% lifetime risk of an extremely deadly type of cancer), and for whom a cure would literally be life-changing, if available.
It's estimated that 300 million people have HBV. HBV is currently incurable once acquired, at which point the vaccine is irrelevant.
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. It is one of the top three causes of cancer deaths worldwide.
Aside from the sheer number of people affected by this, it is also a horrible thing to experience. I have watched someone die from liver cancer, and I would not wish it on anyone.
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 suppressible through antiviral treatment, making it generally untransmittable (if treated and suppressed) and unlikely to cause symptoms. Most people with HSV do not even bother to do this, which is if anything a testament to how little HSV affects their lives (most don't even know they have it, and there is no clinical justification for routine testing in otherwise healthy patients).
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 for a long time and if it causes cirrhosis, approximately one third of people clear HCV infection in the acute stages without any lasting ill effect. 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. So there is no clinical reason HCV needs to increase a person's risk for cancer, as long as they have access to medical care. The same is not true for HBV.
First, while you're correct that most people who have HSV have few symptoms (if any), you're discounting the fact that, because so many people are infected, there are millions upon millions who have highly-visible and highly-painful infections. Many of these people struggle with relationships and mental health as a result.
Second, HSV is associated with higher risk of HIV infection for obvious reasons.
Finally, discovering effective treatments for such a difficult virus would probably produce insights that have implications for other difficult-to-target viruses.
So I don't think we should dismiss HSV on the basis that it's so common and doesn't cause life-threatening symptoms. Medicine should pay adequate attention to infections that affect quality of life for large numbers of people.
Billions are spent on treatments for super rare diseases, many of which are terminal, and in the best cases the end result is often that pharmaceutical companies have drugs costing tens or hundreds of thousands of dollars that extend life by months (often with dubious quality of life).
> 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?
My sister, who is two years younger, was in 8th or 9th grade when this album came out. She's also a Weezer and Radio Head fan. Only a few years difference but I feel this genre came after me.
I'd love to see more work done towards other incurable viruses like HSV (no vaccine) and HPV (limited vaccine)
https://en.wikipedia.org/wiki/Hepatitis_B
Yes, there is an effective vaccine but not everyone has access to it for tons of reasons.
Also, about 3.5% of the world's population already has it. That's about 300 million people for whom a vaccine is pointless, and who are at dramatically higher risk of liver cancer (somewhere between 15-50% lifetime risk of an extremely deadly type of cancer), and for whom a cure would literally be life-changing, if available.
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. It is one of the top three causes of cancer deaths worldwide.
Aside from the sheer number of people affected by this, it is also a horrible thing to experience. I have watched someone die from liver cancer, and I would not wish it on anyone.
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 suppressible through antiviral treatment, making it generally untransmittable (if treated and suppressed) and unlikely to cause symptoms. Most people with HSV do not even bother to do this, which is if anything a testament to how little HSV affects their lives (most don't even know they have it, and there is no clinical justification for routine testing in otherwise healthy patients).
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 for a long time and if it causes cirrhosis, approximately one third of people clear HCV infection in the acute stages without any lasting ill effect. 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. So there is no clinical reason HCV needs to increase a person's risk for cancer, as long as they have access to medical care. The same is not true for HBV.
Link between HSV and dementia
I think this is a bit of an unfair conclusion.
First, while you're correct that most people who have HSV have few symptoms (if any), you're discounting the fact that, because so many people are infected, there are millions upon millions who have highly-visible and highly-painful infections. Many of these people struggle with relationships and mental health as a result.
Second, HSV is associated with higher risk of HIV infection for obvious reasons.
Finally, discovering effective treatments for such a difficult virus would probably produce insights that have implications for other difficult-to-target viruses.
So I don't think we should dismiss HSV on the basis that it's so common and doesn't cause life-threatening symptoms. Medicine should pay adequate attention to infections that affect quality of life for large numbers of people.
Billions are spent on treatments for super rare diseases, many of which are terminal, and in the best cases the end result is often that pharmaceutical companies have drugs costing tens or hundreds of thousands of dollars that extend life by months (often with dubious quality of life).
If so, if a treated patient spreads the virus, will that new patient carry an innoculated virus? Or will they suffer a standard infection?
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".
https://i-base.info/u-equals-u/
U=U probably does not apply to all diseases for the reasons you mentioned though.
This will enable it to be supplied at a non-exploitative price to Africa and Asia.
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?
>AI Engineer @Varnan Labs
Bingo. A glance at their comment history shows this is a pattern for them
My sister, who is two years younger, was in 8th or 9th grade when this album came out. She's also a Weezer and Radio Head fan. Only a few years difference but I feel this genre came after me.