Viral load tests

[apache1]

What amount of viral load is considered low level or occult. ?
Is it common to need a sensitive vl test to detect a low level hbv infection ?

Keep in mind I have NO HBV surface antigens, but do have +HBV total core antibodies. From what I understand so far, there is a small possible chance for a low level, or occult HBV infection, or maybe even a full out HBV infection to be present without surface antigens. This HBV is very confusing...

Is it a good idea for a sensitive HVB DNA test, <2 iu/ml NGI LabCorp...
or is the Quest HBV DNA pcr <100 iu/ml good enough to show occult or low level HBV ?

Is it a good idea to get separate core antibody tests, or is the total core antibody enough.
Will the individual antibodies like   +or-HBV E antibody shed more light on anything at this point.

NP wrote script for HBV DNA by PCR. I know from past experience with hcv that could by anyone of 6 different tests, depending on what the lab tech goes with. I would like to be more specific if needed.
My NP is really great,and will more than likely write up whatever test I want as long as it is appropriate.
Don't want to bother my Hepatologist with this quite yet, till there is more details and data. Might not need to question him at all, if tests comes up neg.

Thanks for any info you can give me,
apache

[bberry]

well i think it is important that you get hbsab tested. if it is postive and present then it may be less likely OBI ( Occult hepatitisB Infection). Steven is the only one on here that i know is both hbsag+ and hbsab+.
now like zellyf said, if you are negative ( which you are as it shows) and still show some type of V/L then it is an indication of an OBI.

im not sure about the technicality of labcorp and quest. they may be irevelant . in fact , i havent used any of the two since i found out i had hepB. been doing my bloodwork at a differerent lab . it may be a good idea though - for the heck of it - to do my next bloodwork at labcorp and see if ther's any difference though i dont expect any.

[apache1]

bberry,
correct, hbsag negative and  hbcab postive (total core anti)

"how about your hbsab ? "
Never got a hbsab test.

Steven in another post said:
"In your case, if your surface antigen is - and core antibody is +, it's likely you are immune by past infection.  Your NP probably didn't order the HepB surface antibody test because your NP assumed it to be positive (again, immune by past infection)."
  That made sense to me, so I assume that is why my NP did not order HepB surface antibody test, along with the total core antibody, and surface antigen tests. ?

I will be getting HepB surface antibody test, HBV DNA viral load, and another total core antibody test done this week.

On the contrary bberry, I am thinking I do not have occult HBV viral load. Or any other viral load.
Unfortunately I do have experience with HCV.
Hopefully next month at my 6 month post tx HCV RNA test, I will continue to be HCV undetectable <5iu/ML Heptimax, as I was at 4 month post peg interferon and ribavirin treatment. That will give me an SVR status (cured) and close a chapter in my life. I am hoping not to open a HBV chapter.

LabCorp offers an available HBV DNA test thats good to **1-2** copies/ML
NGI HBV UltraQual by PCR #140622... Wow, thats the most sensitive Hep test I have ever seen. Think that will show occult...lol ?
Beats the other side. Over there we have for HCV,  pcr 140639 by LabCorp, the most sensitive. HCV goes to <2 iu/ML, thats about *5* copies per ML.... iir HR right.
https://www.labcorp.com/pdf/One_Source_Infectious_Disease_Reference_Guide_1394.pdf

Unless I am missing something, kind of surprised Quest does not offer a competing sensitive test. Quest's best HBV DNA test is only good to <160 copies/ML or 100 iu/ML ? For HCv thats not sensitive enough. guess this HBV is different, or is it ?

Since Quest does offer competing RNA HCV tests, makes me think maybe Quest does not offer a competing HBV test because it is not necessary. What do you all think ? .

Thanks for explaining the HBV vl 2007 guideline levels.  What exactly is OBI ?


zellyf,
Well, not really sure if I cleared a past HBV infection. The last round of tests leave some questions.
Hopefully the tests I take this week will confirm I cleared a past HBV infection or had a false positive total core antibody test.
I agree, unless directed otherwise, will go for the most sensitive 1-2copies/ML LabCorp test.


Thanks for the reply everyone,
apache

[zellyf]

So, your tests indicate that you cleared a past HBV infection?  So if you have any detectable viral load that could indicate an occult infection.  I'm not sure which test is the most sensitive but I'd go with the most sensitive test available. The only times you would really need to worry about an occult infection are if you are donating blood (don't with occult infection) and if you undergo some kind of immunosuppressive treatment (like chemo or radiation).  For the latter, you would need to take a prophylactic antiviral to avoid reactivating the HBV.

[bberry]

2007 guideline suggests that <2000 iu/ml is low level and hbv carrier is considered inactive at that level. it is considered the highest number of IU where no treatment is required for hbv carriers. now the lowest which is considered UND is <100 iu/ml.

not sure if there is a test to detect a number below that or not. i did read that there was a study on making that available . you can ask your NP.

i assume by this statement "Keep in mind I have NO HBV surface antigens, but do have +HBV total core antibodies"  that you are hbsag negative and hbcab postive. how about your hbsab ?  

you mentioned you had an experience with hcv . is that why you think you have OBI ?
OBI doesnt neccessarly have to come with a co-infection though it is a possibility and i dont think by your NO HBV and +HBCAB it means you are occult. possible but hmm eh i am not sure..