Hepatitis B Testing

[Willow2006]

Hey all,

I posted recently under HBV and HCV PCR RNA testing and received great information from everyone.  

I recently posted a question in the doctor's forum that was answered by Dr. H from the STD forum and he recommended I post the question in this forum as well as it was not his area of expertise.  Below is the question I asked him and his response.  I was hoping others especially Zellyf, Cajim, and CoWriter may be able to chime in and provide their opinions.

I can't thank you enough for any advice you can provide !!

Justin


"After being exposed to someone with Hepatitis B, I underwent a series of tests in order to determine if I contracted the virus.

At four weeks post-exsposure, I tested "not detected" for Hepatitis B and Hepatitis C panel tests.  I believe this measured antigens as well as antibodies.

At 6.5 weeks post-exposure, I underwent an HCV RNA PCR QUAL test that resulted  in "Not detected".

Also at 6.5 weeks post-exsposure, I underwent an HBV DNA QN PCR test that resulted with:

PROFILE              <100 IU/ml
PROFILE              <160 copies/ml

I was experiencing some right abdominal discomfort and had an ultrasound conducted.  Results indicated that everything was normal and made mention of that fact that no "ascites" were found.

When I was at my PCP to receive these results, I received the first Hep A vaccination and the first Hep B vaccination (had the first in the series around two years ago and my PCP wanted to repeat it).  I will continue to get the remainder of the vaccinations in the future and to test for antibodies when the series are completed, however I'd feel much better if I knew that I did not contract Hep B or Hep C during my recent exposure.

1.  I would think that Hep B and Hep C would be detectable by 6.5 weeks via PCR, however what is your professional opinion??  Can I consider the PCR tests listed above as conclusive evidence that I did not contract Hepatitis B and C ??  

2.  I had planned on getting an injection of Hep B Immuno Globulin in the event that I did contract the virus and it has not yet manifested itself in such a way that it was not detectable via PCR.  Should I still consider this option??

3.  What other tests should I undergo so that I can be assured that I did not contract HBV and HCV??

Thanks for any insight that you can provide and for all the advice you have given everyone on this forum !!

Justin"



"Thanks for the thanks about this forum, but I cannot be of as much assistance as you might have thought.  To my knowledge, your results are reliable and show you weren't infected with either HBV or HCV.  But many STD experts have little experience with such testing, since we don't generally do much hepatitis testing in STD clinics.  (When we do test, it is for people who are at generally high risk, such as men who have sex with men or injection drug users, but not to look for infection after specific exposures.)

Accordingly, your PCP probably knows more about interpreting your test results than Dr. Hook or I do, including the potential effect of starting the vaccines on the results of the blood tests; you should be asking him or her these questions, if you haven't yet done so.  Or you could check with a hepatitis forum to be certain.  By the way, hepatitis C is generally not sexually transmitted and there is rarely if any need to test after sexual exposures, only after overt blood exposure (e.g., needle sharing).

To the specific questions:

1) I agree, but as I said, this is not in my area of expertise.

2) To my knowledge, it is too late for HBV immune globulin to have any benefit; it has to be given very soon after exposure, certainly within a few days.  But if you are sexually active and potentially exposed to other non-monogamous partners, getting the HBV vaccine might make sense for you.  Discuss it with your PCP.

3) I see no need for any further testing.

Best wishes--  HHH, MD "

[Willow2006]

Thanks so much for your comments.  

I hope, indeed, that I did not contract the virus at all, but I'll update you later regarding later tests.  I'm thinking that I'll get the Hep B Immune Globulin asap regardless of what Dr. H said. As you said Cajim, it can't hurt to get it and since there is no detection of the virus yet, perhaps if it does manifest, the immune globulin can have an effect then.  And of course I'll continue with the vaccinations and the testing for antibodies thereafter.  I'll probably get another Hep B panel test at 10 weeks post-exposure too....

Thanks again for providing advice; it means a lot more than you probably realize !!!

[zellyf]

I think you should take the doctor's advice.  To be beyond certain, repeat the Hep B screen at 6-months post-exposure.  As he said, the HBIG would be of little good to you now but do pursue the vaccine to prevent future exposure.  

[cajim]

1.  I would think that Hep B and Hep C would be detectable by 6.5 weeks via PCR, however what is your professional opinion??  Can I consider the PCR tests listed above as conclusive evidence that I did not contract Hepatitis B and C ??  

---So far your tests did not say you have HBV, let alone chronic HepB

2.  I had planned on getting an injection of Hep B Immuno Globulin in the event that I did contract the virus and it has not yet manifested itself in such a way that it was not detectable via PCR.  Should I still consider this option??

---Vaccination only does good, the worst is when it is not effective.

3.  What other tests should I undergo so that I can be assured that I did not contract HBV and HCV??

---Sounds like you did not contract HepB at all.  After your vaccination, test for anti-HBs.  When it becomes positive, you are immune for life.

Best.