Exactly Which Labs to Request?

[46YearsAgo]

Hi,

I am a very (very!) healthy 60 year old male and was infected with Hep A and B 46 years ago at age 14. It resolved quickly and I've never experienced any symptoms since. Health officials suspected food-borne virus form the school cafeteria since others in my Jr High were also infected. This was 1969 and advanced tools to isolate the virus were not available. None of us kids contracted this through sexual activity or drug/needle use.

A few times in my adult life, when changing GPs or obtaining broad labs, I have been told (reminded) that I carried "markers and antibodies" for both Hep A and B. I have not actually seen those labs, so I don't know precisely which tests have been run. I have not infected my wife or children.

I have been self-employed for several years and have purchased health insurance on the open market and have received the super-preferred rate due to my and my spouse's excellent health, weight, BMI, and other lab panels. Under the new USA health plans, however, the best rate I can find is 2.5X my current cost, so I am joining one of the alternative health-cost-sharing organizations. (Yes, they qualify one to avoid the tax penalty)

My medical disclosure includes the Hep A and B history, so the health director at that organization is asking me for lab information regarding whether my Hep B is reactive or non-reactive. (This is so they'll know whether to exclude anything associated with Hep B) After reading through this forum for an hour or so, I know there are multiple factors to consider, and it's not quite as binary as reactive/non-reactive. I think they really want to know if I am immune via clearance of past infection.

I'll need to get my GP to order some labs that provide the info needed, and I want to make certain I get the right tests done. Are there other code words I should use, or will the Dr and Lab understand I want these three tests?  
I think these are the three key factors: HBsAg  ....  HBcAb  .....  HBsAb     Of course I am hoping for a neg - pos - pos on those but don't want to assume my GP will know exactly what to order.

Is this the correct way to ask my Dr to order the labs? And thank you for reading all of this.

[stef2011]

hbsag below 1000iu/ml reflects immune control and has more chances to clear on pegintf treatment

hbsag below 200-300iu/ml i even better for response to peg

[46YearsAgo]

Well, there seems to be no opinion on whether my situation is unusual or is a common occurrence. If I traveled to another country and obtained a quantitative HBsAg test, what are the ranges and levels of HBsAg and their associated meanings? I understand there is weak correlation between HBsAg and HBV DNA results but am curious what I could expect to learn from this test if I traveled to have it done. (HBeAg negative)   Thanks for your input.

[46YearsAgo]

A little update and a question as to whether my case is unusual or happens often. Looking back at the records, we conclude that I was indeed infected during oral surgery at age 13. Since Hep B and Hep C had not been isolated/labeled in 1968, I was Dx with "Serum Hepatitis". My recent tests reveal I have had Hep B and Hep C (not Hep A as I originally posted).

With Hep B and C for 46 years, we didn't know what we'd see with the viral load since I am surface antigen positive. Well, the news is as good as one could hope for:

My liver is F1, based on the ultrasound with elasticity test. ALT is in the mid-30s for several years.
I am HBeAg negative. My Hep B immunity level (surface antibody) is very, very low.
My Hep B DNA number is 32. That's right: 32.
My Hep C viral load is Undetectable!
My wife was retested and she is negative all the way across the board.

Is it unusual for a patient to present with both chronic Hep B and Hep C when his risk factors have been absolute zero since the initial infection 47 years ago? Are there old strains of Hepatitis that combined characteristics of B and C?

My hepatologist is not even asking me to return for monitoring since my numbers are so low. I'll watch my ALT and will probably get some retesting done in a few years, considering I've made it this long after acute stage.

Thanks for your comments and suggestions.

[46YearsAgo]

Wife was never vaccinated, but will be tested to re-verify negatives and will become vaccinated.

[mike9111]

Maybe tour wife was vaccinated and that is why she was not infected. But get her to get the vaccine if she didn't already.

[46YearsAgo]

As follow-up, a review of the dates reveals my acute event occurred just a matter of weeks after I underwent oral surgery in preparation for orthodontic work. I'm being referred to a local hepatologist for a full evaluation. It is still surprising that I have not infected my wife of 38 years.

[stef2011]

could/would this manifest into symptoms?

none, even from blood tests.when you have symptoms the liver damage is so advanced to be close to death or very difficult to manage (decompensated cirrhosis)

also remember that from US you cannot monitor liver damage but you can monitor HCC to prevent an incurable hcc, so monitoring every 6 months by US is very important to catch hcc when treateable

as to hbv cure we only have sequential treatment by tenofovir and then peginterferon add on.when to add pegintf depends on hbsag quantity less than 1000iu/ml although after 5-7 years of tdf it is possible to respond to pegintf even if hbsag is higher

[stef2011]

you were probably infected already by hbv and just had hav on top of that.it is extremely rare that an adult doean t clear hbv while all babies get it chronic (about 94% chronic although studies are not good on this so it could be little less or little more in real life)

like all other members have the most importan t tests, fibroscan mandatory as soon as possible since after a life of infection liver damage and HCC can be developped on a minority after 40-50yo

hbsag quant in iu/ml not available in US, if you have a chance to move to other coutries consider this test because it is the only test to reflect number of infected cells and possibility to clear hbv definitively by pegintf (when less than 1000iu/ml)

hbvdna in iu/ml
hbv genotype
hbeag/hbeag
liver function tests

[46YearsAgo]

Well, my results (chronic) aren't what I'd hoped for, so I'm now asking for info on what I should expect in the future. My
HBsAb is negative/non-reactive
HBsAg is positive (verified by algorithm coupled with screening index)
HBcAb is positive

So - after all these years, what does this really mean to a person my age? How could/would this manifest into symptoms? And when? Best/worse case please?
What current treatment options should I consider, if any?
Are there steps I can or should take to attempt immunity?
What major expenses are possible?
Thank you in advance for your helpful guidance!

[46YearsAgo]

Thank you for the reply. Yes, I have wondered how I could have been infected with HepB - but physicians have told me I had A and B according to labs from 10 years ago. I'll get myself tested and know the answer soon.

[StephenCastlecrag]

I want to add, after such a long time, your HBsAb or HBcAb may both be negative. Also it may be possible that you were just infected with Hepatitis A through contaminated food, as Hepatitis B is only transmitted through blood to blood contact.

[StephenCastlecrag]

I am not in America, so I cannot answer all your questions. I would think the three tests you mentioned, HBSag, HBsAb, and HBcAb will be sufficient. The lab should not only give you the results, but also their interpretation of the results.
All the best.

[46YearsAgo]

I guess I should also ask: Does it make more sense for me to walk into my local LabCorp or Quest Phlebotomy office and ask for these labs?