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Hbsag quantative test in Europe
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Hbsag quantative test in Europe

Hello,

Since we don't have this test in USA. I'm planing to do it in Italy while visiting Europe next month and I have the following questions:

1) where in Rome I can do the test?
2) how much will it cost me ( hbsag quantity, genotype etc...)
3) do I need an appointment or I can walk in?
4) do they speak English I hope
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Avatar_m_tn
the best place to have it is private labs like synlab because in public hospitals it may be difficult to get access

1) where in Rome I can do the test?
there is a very small lab in rome collecting samples and shipping to main sylab laboratory.it is ll ok but not in the rome center, getting there by public transport very messy, you ll have to take a taxi
all public hospitals and many other private labs have hbsag quant but i dont know if you have access

a very good lab i know in civitavecchia (which is 30-45min train from rome) have both hbsag quan and nagalase test available

synlab is everywhere in the north with their own labs,milan is full of their labs, verona, florence, forli, cattolica too

2 hbsag at synlab is about 50€, i dont know for genotype and other tests.email them, they also have ip10 and other research tests available, oxidative stress tests and so on.hbsag in public hospitals is 8€ for italians and free for italian chronic carriers

3 no appointment but you have to explain carefully the type of test because they dont know it at reception (while public hospitals know the test) and confuse that with hbsag qualitative, hbsab quantitative or hbvdna
they have roches elecsys

4 i guess they do, better email them and have appointment so they dont make the wrong test

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the best place to have it is private labs like synlab because in public hospitals it may be difficult to get access

1) where in Rome I can do the test?
there is a very small lab in rome collecting samples and shipping to main sylab laboratory.it is ll ok but not in the rome center, getting there by public transport very messy, you ll have to take a taxi
all public hospitals and many other private labs have hbsag quant but i dont know if you have access

a very good lab i know in civitavecchia (which is 30-45min train from rome) have both hbsag quan and nagalase test available

synlab is everywhere in the north with their own labs,milan is full of their labs, verona, florence, forli, cattolica too

2 hbsag at synlab is about 50€, i dont know for genotype and other tests.email them, they also have ip10 and other research tests available, oxidative stress tests and so on.hbsag in public hospitals is 8€ for italians and free for italian chronic carriers

3 no appointment but you have to explain carefully the type of test because they dont know it at reception (while public hospitals know the test) and confuse that with hbsag qualitative, hbsab quantitative or hbvdna
they have roches elecsys

4 i guess they do, better email them and have appointment so they dont make the wrong test

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synlab is in austria, switzerland, germany, france, uk and many others so you can have hbsag quant there too i guess
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Interesting that the capital doesn't have a branch of Synlab. But I'm willing to take the train for Synlab how far is it the closest one from Rome?
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Also i found this in Rome, is this the same synlab you are talking about? But i don't see an email to email them

Synlab Lazio S.R.L.
Via di Torrenova, 249 Roma
+39 06 200 6599
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yes i went there, the only trouble is the taxi and to find the small lab which is in a small street from the main street Via di Torrenova

there is a big guy at reception and he knows about hbsag quantification, time is longer for results there while at synlab branches in milan, florence, verona, brescia and so on you ll get it same day or next day online
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Hey Stef2011,

How important is the HBV Genotipo and the mutant test? I'm trying to weigh the cost vs importance.

I'm originally from the middle east and born on the mediterrenean so most likely Genotype D? Or does the test tell you more than that?
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hbv genotype is needed to know the chances to clear on pegintf (but not important for sequential combo) and to exclude not having genotype C which is the most aggressive as regards cancer

precore/bcp, just to know the hcc/cirrhosis risk but not so important
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Thanks Steff, what worrie me the most is that my doctor told me most likely I have precore mutant. Does that mean most likely will end up with HCC?
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no but having both precore and bcp is a good indication to start treatment if hbvdna elevated, firboscan elevated

do not worry too much the most common form of hbv wrldwide is precore bcp
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Thanks again Steff. Great work in this forum, not sure how you are able to answer every one all this years. You deserve a trophy :)
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You are right, Steff is the best man on this forum, He is reliable, generous,very human, our doctor,our advisor, and we should appreciate him. God give him to this forum,and I am sure that everyone is happy that Steff takes care on every single question. We pray for you Steff
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thanks, i just try to bring the most updated info most doctors have no time to review or study so that in  way or another we get the best out of treatments against hbv
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Just a quick update, I decided to do the test in Germany since I'm here for 3 weeks. I went to synlab in Kohln and they wanted a doctor to see me or will have to pay 700 euro for hbsag quantity and genotype. So I called a local doctor and he said he will do these tests for 150 euro so I will go to a local doctor this Friday to get it done and will post the results once I get them
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sounds like a well done fraud of crazy german laws (since synlab is an italian company) and hbsag quant test is 40€ in italy, dont know about genotype but 700€ is a fraud and 150€ is still too much


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Avatar_m_tn
or maybe they are balancing somewhere else with the lowering prices of the tests in italy....
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Yeah that was crazy will let you know the real cost on Friday. I had so much trouble to even do it without a doctor note but will see this Friday what the doctor will say.
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I did the tests today at local doctor in Germany and prices not so bad

Hbsag quantity 14 euro
Genotype          99 euro
Vitamin d.          20 euro
AFP.                   10 euro
Hdl/LDL etc...     50 euro
ALT/AST.            20 euro

Will get the result next week :)
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Avatar_m_tn
very good prices in the end
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Here is my results from the German lab (still waiting on Hbsag quantity):

I notice my ast/alt are higher than 2 months ago. Is this bad?

ALT GPT now 39 (was 20 2 months ago)
AST GOT now 25 ( was 18)
Vitamin D blanc 80 mol/l  ( should be > 50)
AFP   4 (should be < 7)
MCV  81.9 fl ( should be 81.8 - 95.5)
MCH  27.9 pg ( should be 27 - 32.3)
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Avatar_m_tn
slow on results, in italy everything ready later same day.

anyway all results good and with very little meaning for the infection, the most important hbsag quant and genotype to see if peg is a good option

only vitamin d is very bad, only 32ng/ml, best to make it 90-100ng/ml or 250nmol/l

http://www.endmemo.com/medical/unitconvert/Vitamin__D.php
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if they tied hbsag quant with hbv genotype that might be the reason for delay, they usually wait for many requests to sum up so they avoid wasting pcr material
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Why vitamin d is bad? Mine say 80 mol/l when it should be over 50 mol/l
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I guess my confusion was the unit say mol/l is this same as nmol/l ? Also is it safe to start on 5000 iu or 10000 iu vitamin d?
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10.000iu of d3 is a perfect dose and fully natural dose with no need of special monitoring or diet.a good level for immune function is 100ng/ml

try to use labs with ng/ml, i guess other units are just used to confuse people

also monitor pth because we have a lot of interference and resistance on vit d pathways due to hbv, receptor polymorphisms or genetics.when vitd25oh is in the high range the pth must be in the low range of normal, if this does not happen it means cellular receptors are not receiving vit d in circulation and all the vit d is useless
in case of vit d resistance the levels of vitd25oh must be increased over 100ng/ml and no dairies diet and 2L of water needed
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Avatar_m_tn
vitd25oh 80nmol/l or 32ng/ml is considered normal for bone metabolism not so for immune function.
for immune function best to have higher range of normal, studies found good correlation with cancer prevention at high end of norm and also colds and acute infections are extremely low on that range
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What is pth? Is this something they test in urine?
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parathormone
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Very weird I just called the doctor office in germany asking about my Genotype and HBSAG quantity result and the lady told me they couldn't get my genotype because my hbv doesn't exist lol. I knew this isn't true because 2 months ago i had my viral load dna detected at 1154 iu/ml. So I told her this isn't a possibility so she put me on hold and asked her colleague and said the result will be out next week. Does it really take more than 2 weeks for hbsag and genotype?
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in italy it says 10days on synlab website.

very funny i never heard such a thing "your hbv does not exsist...."
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You also got me interested to find my nagalase level but again this test is very difficult to obtain in US and possibly in Europe as well. Do you advise start GCMaf before taking the nagalase test? How much you paid for the GCmaf stuff and how many bottle you purchased?
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GCMaf before taking the nagalase test?

absolutely not.also keep in mind we dont know for sure if it will clear hbv, it did not in my case but i was a severe one and my nagalase is still 1.3, probably 3 years needed or the new formulation with the oleic acid which binds better to cellular receptors
the are also developing suppositories to reach the liver, i d wait for it.they also tried liposomes but they did not work to deliver any gcmaf form

taking nagalase test is wise anyway because having something which hijacks our immune system is never a good thing.also keep in mind that response to gcmaf depends on the vdr receptors too

labs making the test
http://www.europeanlaboratory.nl/pages/body.php?menu=378&PHPSESSID=77bf658f4449ace6a4b3e677207fe700

www.redlabs.com

http://www.gc-maf.de/index.php/en/2-gcmaf-general-information/17-nagalase-blood-test-labs

italy, public hospital research university
Azienda Ospedaliera Sant' Andrea Rome
booking is required and they take the test on wednesday only, 60€, doctor request for the test needed
http://associazionemara.com/pml/nagalase.html

test available in private labs in civitavecchia, monza, caserta.quite expensive because you have to pay the low temp courier shipment while in rome hospital you just pay the test
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i have no idea of the money i spent on all supplements and gcmaf, a lot for sure but i prefer health i dont care about the money

i used the UK lab which is the one supplying research centers and most published in scientific journals.their goleic (gcmaf+oleic acid) is 450€ per vial (8 injections).it has to be kept at 4° and lasts 8 weeks at this temp

there is also a japanese research group supplying another type of gcmaf, it is highly concentrated and cheaper but i dont know if it works as much as the european one

also israel has a research group, they use the old gcmaf molecule developped by prof yamamoto, the discoverer of it.i dont remember price but it was superoverpriced.
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this said gcmaf is proved to work on cancers incredibly according to the ltest publications and also improve autism/CFS but i have seen no published case reports at all on chronic viral infections
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Thanks for info. I'm on total loss as this nagalase test difficult to get in usa
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http://www.hdri-usa.com/tests/nagalase/

I had the nagalese test through this company in New Jersey. They'll send you the kit and a UPS box to return the blood sample. It was very easy.
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Cool Jamesdc thanks alot for the info. Did you take the kit to a lab and they prepare it for you?
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i didn t menthion this lab because a doctor from new york found unreliable results.
i think the problem is with temperature because they allow shipment with no cooling overnight, while years ago i checked with eruopean labs and they required cooling even if overnight shipment

i think the best is going to the lab directly or using dry ice for cooling even if overnight
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I took the kit to my doctor's office for the blood sample and then sent it back overnight. I was unaware of the problem that Stef mentions so next time I'll either take a day and drive to the lab or use dry ice in the package.
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Yeah maybe go to New Jersey not so bad for me 8 hours or perhaps fly there.
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i cannot be 100% sure about this because these were just reports from this doctor but it makes sense to go directly at the lab

he took multiple blood samples from same patients at the same time to see if the nagalase results would be the same and he found different results from same sample at same time

also remember to mention drugs and supplements taken
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Got my results:
HBSAGQ  HBs-Ag (quantity) (ECLIA).  223.70 iu/ml
Hbvdnq.   Pcr.  38200 iu/ml.  (Was 1128 iu last month?)

Genotype. D
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in italian we say "che culo....."

well you can easily clear in few months, i would go same protocol as otan did, that s to say:

optimize vitamin d before starting
simvastatin few weeks before starting
peginterferon pegasys hbsag level guided therapy (it lasts as long as hbsag goes und and hbsab>10miu/ml)
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Is the number 223.70 iu/ml from eclia reliable? I never done hbsag in the past so I'm clueless. Also why my hbvdna pcr is 38200 iu/ml and when measured in USA last month showed 1128 iu/ml?
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hbvdna is not the same number for every machine, it changes with machines used and may also change day by day according to host/virus reactions.my sister found more than 1log difference using different labs ad then machines

ask the lab which machine was used for hbsag quant, eclia is the qualitative test but maybe they just wrote uncorrect things.anyway i would have done that in italy, healthcare cannot make mistakes here because you can sue for huge amounts

abbott architect is chemiluminescence method
roches elecsys is CMIA method (synlab italy has elecsys)
eclia is qualitative, i don t know if there is a method to do it quantitatively

http://www.ncbi.nlm.nih.gov/pubmed/23967740
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also check lower level sensibility cut off, architect and elecsys have 0.05iu/ml

better get things very clear, if the result is wrong going for peg with values >1500iu/ml might be a waste of money and also severe sides effects for nothing
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Here is what the paper say please let me know what you think:

Hbsagq HBs-Ag (quant.) (ECLIA)  223.70 iu/ml    +   < 0.05
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sorry, i checked my synlab hbsag test and it sayd eclia too, so that is perfectly correct.so they used elecsys roches like in italy and your results are very correct


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http://www.medhelp.org/posts/Hepatitis-B/After-16-week-with-Interferron--Simvastatin/show/1680711

this is otan experience, of course it makes no statistics one person, but these are ideas on how to manage our treatment with peg.while the fact of almost certain response with such a low hbsag is a scientific fact
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I expected my hbsag to be above 6000 due to now I have fibroscan 7.6 and ultrasound show coarsened echotexture in liver
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Also on your report they used comma ? Why they don't round 223.70 to 224?
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in europe we use comma for numbers, using a point means 223700

you have high immune activity in the liver, which of course makes liver damage.according to the fibroscan you can make treatment, at least according to euro/italian guidelines

how is your vitd25oh?i would start with this immediately and then when you go back to US think about the pegintf treatment although it maybe difficult to monitor without hbsag quant, you know you can have hbvdna und and normal ast/alt by peg but be total no responder for hbsag
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but anyway i guess that starting with 223iu/ml would make non response almost null.the problem is in case of slow responder, you need to know the quantity to chooce length of therapy and if going beyond 48weeks worths
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Are you saying that 223.70 iu/ml that I have a very high hbsag? I'm lost as I thought that was low.
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Let me be clear the report used "dot" so it is 223.70 iu/ml should this be interpreted as 223 iu/ml or 223700 iu/ml because this makes big difference
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anyway result is 223iu/ml and it is an extremely low hbsag which clears by pegintf in the highest percentage
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You scared for a bit :)) happy to hear. My alt/ast within normal range and my vitamin D is 32 ng/ml and will start on 10000 iu pills
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I have an appointment on September 17th with An Lok ( she was on board of arrowhead, Gilad etc...). I will tell her about all the info And will also ask her about the new drugs. She wrote many books and guidelines on hbv/hcv. For hbsag quantity I will travel to get it if I have to :)
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One more question for you Stef(I do really appreciate your time);

Would it be better to do peginterferon + tenefovir
Or peginterferon + simvastatin
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very good question which i was including already in a previous answer but then i thought these are just gusses, i dont have real data

i dont think tenofovir can help because hbvdna is already low and immune system needs some virions around for better stimulation whiel on peg.i would go with peg+sim like otan did and only in case of no response i would go for tenofovir and then pegintf add on

this just a guess, no scientific real data here according to me:
i dont think peg+tdf all at once has a big advantage in this case, hbvdna is already low and suppressing hbvdna too much by tdf might lower immune activation.

maybe it would be advantageous with a high hbvdna prof an lok or studyforhope have more knowledge on this for sure
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maybe it would be advantageous with a high hbvdna prof an lok or studyforhope have more knowledge on this for sure

i mean:
peginterferon+sim (which we should consider pegintf mono, no real data on sim add on for hbv) vs peginterferon+tenofovir (not sequential, all at once) with low hbsag quant and low hbvdna quant
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Thanks Stef I will keep you posted of what I will end up using and what the professor say
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Just got my confirmation on qHBSAG results 2 weeks after making the first ever qHBSAG test.

1st qhbsag (August 17 / 2014) 223.70 iu/ml
2nd qhbsag (August 30 / 2014) 220.80 iu/ml

What does coarsened liver on ultrasound mean compared to 7.6 fibroscan result?

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What does coarsened liver on ultrasound mean compared to 7.6 fibroscan result?

nothing special, US was able to see reflections due to fibrosis, but it has no real values because soemtimes you see that sometimes you dont, US is very bad to see liver damage.anyway 7.6kpa is just close to the borderline when therapy is a must

very lucky hbsag is already on the slow decline, peg should have a very fast result
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I must come to Italy to thank you in person if it does really clear :)
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when your hbv population will be killed that will be the best thank you

i really hate this mf virus so much...
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Ok just came back from my appointment with Professor Anna Lok which supposed to be one of the best HBV specialists. Below is a series of my questions and her answers so any please feel free to comment:

1) Dr. Lok what do you think about my results and how you interpret them
HBV DNA 38000 iu, hbsag 224 iu, HBEAG NEG, ALT and AST withing normal range?
   DR Lok: looking at your HBV DNA history it looks like fluctuating between low and little high and in june it was 1100 iu and in august 38000 and that change beleive it or not could be related to time zone difference as there is some research about that change with viral load. We will repeat the tests and see if it come back lower then no treatment and will monitor again after 6 months if it comes high again then interfron for 1 year or possible mix with antiviral and interfron.

2) What is my chances to clear on interfron with such a low hbsag quantity which is 224 iu/ml?
You have to be lucky to clear because usually it is hard because you are HBEAG neg and percentage of cure is much lower. HBSAG quantity considered low if under 100 iu and high if above 1000 iu so at 224 you are low but not so low.

3) What is my chances of getting HCC and is it really 0.5 percent increase every year pass?
Currently and based on the results I have your chances of HCC are less than 1% and your chances getting up if you smoke or use alcohol or being obese but since none of that then your chance is less than 1% for the next 5 years and will increase after age 50.

4) What about the new drugs such as Replicor and ARC525 and will we get a cure anytime soon?
There is several companies working on a cure but that will not make it to market before 5 years from now. However since the competition is complete now with Hepititis (hepatitis) C the effort is been shifted to Hepititis (hepatitis) B.

5) What do you think of Fibroscan 7.6 result/
Fibroscan result is just one reading and we don't have history of your result plus it is more reliable for hepititis (hepatitis) C patients than hepititis (hepatitis) B patients because many factors could play into the result.

In summary if your HBV viral load comes up in today's blood test then will recommend treatment with interfron for 1 year. If not high then just watch. The reason why she doesn't recommend treatment because she beleive not much damage in my liver and still young to start treatment.

All the wording above are my own wording and not the exact wording the prefessor said just on the safe side :-)
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I've received my results today and my viral load is now 9400 iu/ml with ALT 55 and AST 35. The professor still undecided on treatment and suggested another same tests in 3 month from now to decide if treatment is necessary.
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With your hbsag of 220 iu elevated ALT and High viral load you should start interferon treatment immediately. because

1) With so low hbsag you have a good chance to clear it by INF
2) If your VL stays that number most likely more cells will be infected in the  liver and HbsAg will go up never to return to so low figure.
3) High ALT means that your immune system is not fully fooled by HBV and responding to the virus so it may well respond to INF as well




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I wish my professor agree to this as my viral load since I started checking it in 2007 fluctuate between 900 iu and 30000 iu
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Guys I'm a bit panicking is it safe to wait 3 to 6 months to my professor to finish her analysis before starting interfron? or does HBSAG quantity raise fast during the 6 months from 220 iu to above 1000?
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I think it is safe.
My case: without medications 3 years.
fibroscan  (for the first time I did) 2 times during last 6 months without change (always F2),
hbsag was going down during this time.
Hbvdna was going up.

I am hoping that I am right:)
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Avatar_m_tn
vit d might be lowering your hbvdna, although we cannot say for sure because response to vit d varies so much, it may be possible it gets hbvdna lower

i dont know i would not stop vit d and would force doctor on pegintf treatment
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Thanks elis and Stef. I'm on vitamin d3 and taking 10000 iu daily. So hope in 6 months the professor will be convinced
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