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.

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.

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.

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.

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 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?

This comment smells like Claude.

Is This It

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.