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What does this mean? (EBV TESTS)

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by cfs_ebv_hiphop, Dec 14, 2017.

  1. cfs_ebv_hiphop

    cfs_ebv_hiphop

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    Hi, I was diagnosed with Epstein-Barr Virus like 2 years ago, as symptoms continued I decided to repeat the tests, I am not doctor so I'm looking for advice on what this means:

    2 Years ago:
    Epstein Barr Virus (VCA) IgG U/ml = 139.0
    Epstein Barr Virus (VCA) IGM U/ml = <10

    Now:
    Epstein Barr Virus (VCA) IgG U/ml = 188.0
    Epstein Barr Virus (VCA) IGM U/ml = <10

    So all this means is I'm still sick, right?

    If so, am I contagious?
     
  2. Ema

    Ema Senior Member

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    To differentiate a chronic infection from a past infection, you need to test Early Antigen IgG. It's not possible to say whether those results represent a past infection or a reactivation without that test.

    See the table here for additional details.
     
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  3. cfs_ebv_hiphop

    cfs_ebv_hiphop

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    Thanks
     
  4. Hip

    Hip Senior Member

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    I think (but am not sure) for ME/CFS purposes, either an elevated EBV early antigen (EA) and/or an elevated EBV virus capsid antigen (VCA) can indicate an active EBV infection.

    I have to consult my own roadmap of chronic fatigue syndrome treatment, because my memory is too poor to remember these things, but in the roadmap its says:

    In Dr Lerner's paper he says:
    That's where I got the info to put in the roadmap.



    @cfs_ebv_hiphop, does it say on your lab report whether your results are indicative of an "active infection", "past infection", or words like that?

    If you do have an active EBV infection, you might want to check out Dr Lerner's antiviral protocol for EBV.
     
    Last edited: Jan 9, 2018
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  5. cfs_ebv_hiphop

    cfs_ebv_hiphop

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    Interesting, do you have a link where I could find that protocol?
     
  6. Hip

    Hip Senior Member

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    From the roadmap of chronic fatigue syndrome treatment:
     
    Last edited: Jan 9, 2018
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  7. Gingergrrl

    Gingergrrl Senior Member

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    @Ema or @Hip How would the "EBV PCR Quant (Whole Blood)" fit in with all of this? Mine is currently positive at 110 and it says, "The quantitative range of this assay is 100 to 1 million copies/mL". Both of my doctors said it is positive, and I am not doubting this, but am trying to understand what 110 means since there is no real range or titer? I will be re-running it at the end of Dec to see if the number has increased or decreased. Thanks in advance!
     
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  8. Ema

    Ema Senior Member

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    A positive IgM VCA, not IgG, is indicative of an active infection. But the OP's IgM is neg.

    "A diagnosis of Epstein-Barr virus(EBV) infection is made with a positive EBV EA antibody diffuse and/or a positive VCA IgM antibody."

    http://www.treatmentcenterforcfs.com/documents/MECFSTreatmentResourceGuideforPractitioners.pdf

    My experience with Lerner is that he typically measured the IgG titer after the initial round of testing.
     
  9. Ema

    Ema Senior Member

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    A PCR test measures copies of viral, in this case EBV, DNA in your blood per mL. So your result means that viral DNA was found in your blood. Typically this is not where the virus likes to hang out, so it is not a foolproof way to test either, unfortunately.

    Obviously defer to your own doctor, but my understanding is that results under 5,000 copies/mL are of limited diagnostic value and may not be reproducible...at least according to Mayo's lab. ARUP doesn't report under 390 copies/mL either.

    Sadly, all of this testing is subject to interpretation and fraught with problems. This article goes even further to say that there is no correlation between serological parameters and viral load.
     
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  10. Gingergrrl

    Gingergrrl Senior Member

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    So the PCR test strictly means that there are viral copies of EBV in the blood but (if I understand you correctly?), the virus does not generally hang out in the blood? Does it normally stay inside of the cells? What would be the most foolproof test for EBV (or are basically none of them reliable)?

    I'll be doing a phone consult with him next week and have all of my lab results but have not discussed them w/him in detail. I bookmarked this post and all three of your links so I can review them before I talk to him. I definitely prefer not to go back onto an anti-viral but will if it's absolutely necessary.

    So even if the PCR/blood level was very high, it would not correlate with someone's viral load? I am not sure what that means unless it is referring to symptoms? I have zero viral symptoms (no fever, no sore throat, no swollen lymph nodes, no sick or malaise feeling, etc). My worst symptoms remain POTS/autonomic dysfunction. But I am also doing high dose IVIG which is protective against these viruses and my numbers might be higher without it. I really am not sure?!
     
  11. Hip

    Hip Senior Member

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    I am glad that you are sharp and observant, @Ema, as I completely missed that!
     
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  12. Wonkmonk

    Wonkmonk Senior Member

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    But if I'm not mistaken, Dr Lerner also treats high IgG titers as evidence for active infection, at least for CMV and HHV6, but possibly also for EBV (I don't remember that exactly).
     
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  13. Wonkmonk

    Wonkmonk Senior Member

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    I think no one has commented so far on this question: I would say you are not, because IgM is negative, but even if you were, 98% of the population is infected with EBV by age 40 and once infected, they also have immunity (unless they are immunocompromised and in that case their "own" EBV reactivates), so the risk of infecting others is probably not a big problem. The exception would be if you have contact with a seronegative, immunocompromised individual, e.g. a pregnant woman. Then she might contract first infection of EBV and in an immunocompromised state, EBV can cause complications. But for immunocompetent people, even if they are not infected, it doesn't cause big problems and at some point in their lives, they will almost certainly get infected anyway.

    That's at least my understanding, hope others will comment, too. And it is always important to check everything on this forum with a physician.
     
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  14. Gingergrrl

    Gingergrrl Senior Member

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    I was the one freak of nature who some how managed to not be exposed to EBV until I got severe mono at age 41 following a minor surgery. I had been tested in the past (due to chronic tonsillitis and other issues) and was IgM and IgG negative until getting Mono at 41 when I became IgM positive. Then for 3-4 years I stayed IgM, EA, and IgG positive.

    During the time that I had severe mono, not a single family member or friend caught it from me including my (then) fiance nor my mother, both who had never had it to the best of their knowledge. Although I did everything humanly possible to isolate myself so no one was exposed.
     
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  15. Ema

    Ema Senior Member

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    Yes, I would say that is true...Lerner definitely diagnosed me with CMV and HHV6 based on high IgG titers (and negative IgM).

    However, I think that was an inference (that may not have been correct, or maybe reflected his hypothesis of an abortive infection) that the current viral testing really isn't able to support. If he had had time to really prove his theories, we might know more now about what these tests really reflect, but sadly his work was cut short by his passing.

    In terms of EBV, there is better testing available to detect a reactivated infection, namely positives to the early antigen IgG. Without that, I'm, at least, unwilling to speculate about reactivation vs past infection.
     
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  16. Ema

    Ema Senior Member

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    I am totally confused about it all now myself after doing more reading!

    But yes, the PCR test means that there are copies of viral DNA in the blood. The normal result for this test is negative for viral copies in the blood, and yes, the virus prefers tissues to blood, though will certainly be present in the blood during asymptomatic viral shedding or an active infection. Viral shedding can happen in anyone who has ever had the infection.

    However, Quest says that there is a difference in PCR results depending on whether or not the sample was taken from plasma or whole blood.

    So that seems like it would be a relevant distinction...but I'm not sure how it could be clinically useful. It doesn't seem at all wise to treat a latent infection without symptoms unless you are an organ transplant patient with HIV or something.

    It seems like that is what they are saying in that article, but I'm sure that is a point of contention among practitioners.

    Let me know how it goes! I'm curious for sure.
     
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  17. Learner1

    Learner1 Forum Support Assistant

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    I'm seeing a top ME/CFS specialist who diagnosed me with chronic EBV with a high VCA IgG and a positive PCR. He said I definitely had it, even though all other types of EBV tests were negative over the previous 18 months.

    From what I understand, EBV doesn't behave the same way in everyone and has some oddities in its replication making it hard to find, especially in those of us whose immune systems aren't working well.

    The doctor put me on 1.8g of valganiciclovir and my brain fog began to clear and energy improved. I'm still dealing with the autoimmunity the EBV seems to have caused.
     
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  18. Gingergrrl

    Gingergrrl Senior Member

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    @Ema would you say that the Early Antigen test is a better predictor of active EBV (that needs to be treated with an anti viral) than a positive PCR test? I'll def let you know what happens after my phone consult next week and am getting so confused re: this issue now!
     
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  19. Ema

    Ema Senior Member

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    I would say that they are both pieces of a puzzle that have to be interpreted by a professional taking symptoms and the whole picture into account. In your case, taking rituximab, as well.

    I’m also curious what your IgG titers would look like after rituximab. If you have no B cells, does that mean no antibody response?
     
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  20. Gingergrrl

    Gingergrrl Senior Member

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    @Ema I believe I would still make antibodies b/c I asked my doctor (pre-Ritux) if I needed to be revaccinated for anything post-Ritux and he said absolutely 100% no. He said the vaccines are in the memory cells (this is from memory and not his words) and they are untouched by Ritux so I assume the antibody response would be similar?
     

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