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Core Antibody related question from Apache1
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Core Antibody related question from Apache1

Apache1’s original post:

Hey Steven,
The HBV core antigen is a protein in the virus physical make up, therefore this antigen is not in your blood.  That's the reason why we don't have a marker for "HBcAg" via blood test.

HBcAb is an antibody that is develop by our immune system in response to that antigen.

Couldn't this also mean there are core antigens present, and thats why the body is still producing core antibodies... just thinking out loud all this HBV is very new to me. Is there no test for core antigens ? or would this take a cellular type test instead of a blood test ?

I have:
- surface antigens  (pre and post hcv tx - )
+ total core antibodies  (only tested post hcv tx )
-core IGM antibody  (only tested pre hcv tx )
no surface antibody test yet, wonder why NP didn't order it?  

My NP told me if I ever have to go on immune suppressant drugs, I should take drugs to suppress HBV before starting chemo.
I am wondering why, if all I have is the core antibodies you speak of.  
What would cause the HBV to reemerge if no antigens are present ?
Are core antigens still present, maybe causing the body to make core anti bodies ?... and the immune system is keeping things in check.

If this core antibody is indeed only a left over, and not an immune response to current antigens, then you bring up a good point Steve. This new treatment causing antibodies to disappear might not be a good thing for our immune systems in the long run.


StevenNYer’s response:

>>>"Couldn't this also mean there are core antigens present, and thats why the body is still producing core antibodies" <<>>"My NP told me if I ever have to go on immune suppressant drugs, I should take drugs to suppress HBV before starting chemo. "<<<

If your posted labs are accurate, you are probably immune to HBV.  Check to make sure your HepB Surface antibody is positive.  Maybe even a HBV DNA to make sure it;s UND (undectected).  If so, I don't think you need to make antivirals meds before starting chemo.  I think this recommendation is for people who have chronic and inactive HepB.  If you NP insist on not confirming the test and want you to go on antiviral HepB meds, see a second opinion.  That's what I would do anyway.  Good luck.

Apache1’s response:

"want you to go on antiviral HepB meds"
I by no means have to go on chemo.
And thats a BIG NO for going on HBV antivirals for a virus I don't have.
My NP by no means suggested that. In fact she said I do not have HBV or inactive HBV.

NP said if I ever HAVE TO IN THE FUTURE,  for some unknown reason at this time,
(possible future illness), then and only then, since I have the 'hbv total core antibody' and no surface antigen -, I should do hbv antivirals BEFORE chemo.

From what the np tells me, -surface antigen, +hbv total core antibody + chemo induced  immune suppression can bring hbv back. ?
Is this correct ?

And from what you where saying in this thread about disappearing core antibodies, I though it relevant. If HEP B Core AntiBodies are gone from this new treatment, could that possibly mean any remnant core antigens are gone too, and no amount of immune suppression can re activate the HBV ?

Have not had a chance to talk to my Hepatologist yet about this new to me HBV core antibody thing.  When I go back for my HCV SVR test next month, will talk to him.

I am a very layperson when it comes to this hbv. Sorry for kind of getting your thread a little off topic cajim, I wish you the best of luck with this treatment if you do decide on it.

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"From what the np tells me, -surface antigen, +hbv total core antibody + chemo induced  immune suppression can bring hbv back. ?
Is this correct ?"

I think currently there's conflicting views on this.  

The problem is that even for those who clears HepB, some, maybe most still will have HBV DNA in their blood.  Very very low amount that a standard PCR assay will register it as UND.  But it's there.  A ultra sensitive assay (like the ones they use for advance research) will probably catch it.  But for all intended purposes, you cleared and are cure.  But for those who need chemo and / or take immuno suppressing meds, your immune system will take a hit.  So the fear is will it hit it to the point where it can no longer hold the very very low DNA?  If it can't, then the concern is reactivation of HepB.  I'm guessing that it would depend on various factors which is too advance for me to even give an opinion on.  So when someone needs to cross this road, talk to a Hepatologist.  Then your Hepatologist can dance with the Immunologist and provide that person with a case specific answer.  

Thanks for the reply and reposting in a new thread Steven.

I will take your advice and request a surface antibody test and a HBV DNA test.

On Quests site it seems their most sensitive test I could find only goes to 160 copies per m/l or 100 ui/ml. Do they not offer TMA test for HBV ?
What is the most sensitive HBV DNA test commercially available to us. Does LabCorp have a better one than Quest ?

For HCV we have <5 Quest and <2 LabCorp, both tests sensitive enough to detect occult  virus in the blood.
Is <160 copies per m/l good enough for HBV to show no occult virus ?

You're welcome.

I believe the 160 copies per mL and 100 ui/mL is standard around here.  I believe LabCorp and Quest both use this one.  There is one that alot more sensitive and comerically available.  It suppose to be able to catch 2-3 virions per mL.  It's call the NFI assay but I don't know under what circumstances is that ordered or it's overall availability.

I'm not familiar with HCV or TMA.

When you go back to the C forum, give the regulars there my best :)
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