What qualifies as a "high titer count" for EBV and HHV6? Help understnading labs

[lady-day]

Hi,

I'm new here on the forum, though I have been dealing with fatigue for the past year and a half.

I went to see a doctor specializing in CFS, we did some bloodwork and she said I do have CFS based on my EBV and HHV6 readings. I would love some help fully understand my lab work.

Here are my EBV results:
EBNA Ab/IgG: (Positive) Result: >8.0 Reference: <0.9
EBV Capsid Ag.Ab/IgG: (Positive) Result: 3.4 Reference: <0.9
EBV Early Ag.Ab: (Negative) Result: <0.2 Reference: <0.9
EBV Capsid Ag.Ab/IgM: (Negative) Result: .05 Reference: <0.9

My understanding is that once you have been exposed to EBV both EBNA Ab/IgG and EBV Capsid Ag.Ab/IgG stay present for the rest of your life. I had a bad case of Mono as a kid, so the fact that they are present is not surprising. But what I have read online is that if these levels are significantly elevated that can suggest reactivation (even if the EBV Early and EBV IgM are negative). But I am having a hard time figuring out what constitutes a "high titer count" particularly because most of the readings I see are formatted as 1____. How do I translate a decimal reading into a 1_____ ?

Here are my HHV6 results:
Herpesvirus-6, IgG AB (3): (Positive) Result: 1:80 Reference: < 1:80

I am confused about this reading because while it indicates infection (and most people are infected with hhv6) 1:80 does not seem very like a very elevated titer to me. I read else where that IgG > 1:230 was considered an elevated titer.


The Dr. prescribed me Famvir, but if the EBV is the more significantly elevated reading than I wonder if maybe Valtrex would be a better antiviral? Does anyone have experience with either?

Any feed back would be appreciated.
Thank you!
Day

 

[SOC]

Famvir is also used for EBV and anecdotal evidence suggests it works better for HHV6 than Valtrex does, so it does make sense that you'd be prescribed Famvir. Also, some docs have been finding Valtrex-resistant EBV is some areas, so Famvir is sometimes used there instead.

Drs Klimas and Rey often use Famvir first because, in general, they find it more effective. They are among the best ME/CFS docs in the world.

 

[lady-day]

Famvir is also used for EBV and anecdotal evidence suggests it works better for HHV6 than Valtrex does, so it does make sense that you'd be prescribed Famvir. Also, some docs have been finding Valtrex-resistant EBV is some areas, so Famvir is sometimes used there instead.

Drs Klimas and Rey often use Famvir first because, in general, they find it more effective. They are among the best ME/CFS docs in the world.

Ok, that's good to hear!
Thanks SOC

 

[heapsreal]

Have u been tested for cmv?? Famvir can help with this. Also try to get an nk function test and lymphocyte subset test to help confirm things and use all of them too se if treatment is helping??
Also immune mods can help nk function if low and improve the immune systems antiviral effects??

 

[lady-day]

Have u been tested for cmv?? Famvir can help with this. Also try to get an nk function test and lymphocyte subset test to help confirm things and use all of them too se if treatment is helping??
Also immune mods can help nk function if low and improve the immune systems antiviral effects??

Hello Heaps,

Thanks for your note and for taking a look at my post.

I have not been tested for CMV. I just did a little research on it, seems like a good idea to get this checked out.

I did get an Immune Deficiency Panel done. Everything falls withing the "normal" range. The only things that stand out to me are that the T Suppressor%(CD8) is high-normal, while the B Lymphs(CD19)(Abs) and NK Lymphs(CD16+CD56) are low-normal.

Here are the full results:
T Lymphs%(CD3) Result: 77.6 Ref: 58.1-86.8 Units: %
T Lymphs (CD3)(Abs) Result: 1181 Ref:755-2903 Units: cells/uL
T Helper%(CD4) Result: 37.9 Ref: 25.6-59.8 Units:%
T Helper(CD4)(Abs) Result: 577 Ref: 315-1843 Units: cells/uL
T Suppressor%(CD8) Result: 37.4 Ref: 17-38.9 Units:%
T Suppressor(CD8)(Abs) Result: 569 Ref: 239-1166 Units: cells/uL
Helper/Suppressor Ratio Result: 1.01 Ref: 0.40-2.80
B Lymphs%(CD19) Result: 10.0 Ref: 4.1-24.4 Units:%
B Lymphs(CD19)(Abs) Result: 152 Ref: 84-848 Units: cells/uL
NK Lymphs%(CD16+CD56) Result: 10.9 Ref: 3-21.7 Units:%
NK Lymphs(CD16+CD56) Result: 166 Ref: 19-651 Units: cells/uL

Does this test show NK function or is that actually a different test?


Thanks for the tip on the immunomodulators. Do you recomend herbal or pharmacutical Immunomodualtors? Is there a specific drug or herbal company you have found to work well?

And lastly do you have any tips on the what qualifies as a high titer for EBV? I guess I want a confirmation of EBV's activity before I embark on six months of meds.. particularly because the HHV6 is barely elevated.


Thanks again,
I appreciate the feedback.
Day

 

[SOC]

@lady-day
There is no absolute borderline for what level of EBV or HHV6 antibodies in the blood justifies treatment. It is simply not clearcut. There are many factors to be considered -- patient age, time since original infection, trend in titres over time, ability to produce antibodies, immune status, and most importantly, symptoms of illness. The best you can do is find a top doc and rely on his or her professional judgement. It would be nice if there was an absolute guaranteed yes/no test, but there isn't.

You didn't report your NK cell function, which is commonly low in ME/CFS. You can have normal numbers, but low function. Based on the immune tests you've reported you had, I'm guessing your doc is also having the NK cell function test done. It takes a couple of months to run so you probably won't get the results back the same time as your other immune test results.

FWIW, Famvir is a pretty safe med, so it is probably worth a try if you have symptoms consistent with herpesviral infection.

 

[Hip]

Titers fall in the sequence: 1:10 ... 1:20 ... 1:40 ... 1:80 ... 1:160 ... 1:320 ... 1:640 ... 1:1280 ... etc

Or else into the sequence: 1:8 ... 1:16 ... 1:32 ... 1:64 ... 1:128 ... 1:256 ... 1:512 ... 1:1024 ... etc

The higher numbers towards the right of these sequences indicate higher levels of infection. So for example, a result of 1:640 indicates more viral activity than a result of 1:80.

If the titer level of your infection is high enough, then you have an active infection going on, or reactivated infection. If the titer result is slightly lower, then you have the virus in your system, but the infection is not active, or less active. If the titer result is very low, it indicates that you don't have the infection at all (it is not in your body at all).


If you look at this study, it indicates that:

HHV-6 IgG antibody titer of 1:320 or more suggests an active infection.

EBV VCA IgG antibody titer of 1:1280 or more suggests an active infection.



However, I am not too clear on how to convert a 1__ titer reading into a decimal reading and vice versa. I have asked this question before on this forum, but I did not get an answer.

 

[Hip]

@lady-day
After doing some more searching, I found some information, in the context of the rabies virus, regarding how to convert a titer value (which is given as a ratio such as 1:80) into a decimal reading (which is given in the units IU/ml).

Both the following two web pages give the conversation formula between titer values and the IU/ml values for the rabies virus:

RFFIT - RESULT INTERPRETATION - HUMAN

What is the Rapid Fluorescent Focus Inhibition Test (RFFIT)?


However, I have not been able to find a formula for conversion of titer values to IU/ml values for all viruses.

Note that IU/ml = international units per mL of serum.

 

[lady-day]

@lady-day
Hi SOC,

Thank you for clarifying about the NK Function test, will ask my doctor if these are underway already or not.


I think that part of the hesitation is that I don't have classic ME/CFS symptoms. I have been having fatigue issues for the past year and half, after coming down with cold like symptoms. And I do feel like I never fully recovered. But my symptoms are mild compared to some of the ME/CFS accounts I have read. I am not bed ridden nor do I have joint inflammation. I have been able to maintain a part time job, though I definitely don't feel like I am as good an employee as I used to be. I feel tired all of the time, the mornings are usually the best and things gradually worsen, often crashing in the evenings. Sometimes a nap helps, sometimes it doesn't. Certain days the brain-fog will be really bad and I won't be able to process or retain any information.

While my symptoms are relatively mild I still feel distressed that I have lost my life force and vigor.

I hear what you are saying about Famvir being relatively safe. And it seems worth giving it a go.

Thank you for having this conversation with me. It has been hard to connect with people around my health. I really appreciate you sharing what your knowledge with me.

 

[lady-day]

@lady-day
Hi HIP,

Thank you very much for this technical information. I will take a look through the three links you provided. And see what I can discern.

 

[SK2018]

Get a

Hi,

I'm new here on the forum, though I have been dealing with fatigue for the past year and a half.

I went to see a doctor specializing in CFS, we did some bloodwork and she said I do have CFS based on my EBV and HHV6 readings. I would love some help fully understand my lab work.

Here are my EBV results:
EBNA Ab/IgG: (Positive) Result: >8.0 Reference: <0.9
EBV Capsid Ag.Ab/IgG: (Positive) Result: 3.4 Reference: <0.9
EBV Early Ag.Ab: (Negative) Result: <0.2 Reference: <0.9
EBV Capsid Ag.Ab/IgM: (Negative) Result: .05 Reference: <0.9

My understanding is that once you have been exposed to EBV both EBNA Ab/IgG and EBV Capsid Ag.Ab/IgG stay present for the rest of your life. I had a bad case of Mono as a kid, so the fact that they are present is not surprising. But what I have read online is that if these levels are significantly elevated that can suggest reactivation (even if the EBV Early and EBV IgM are negative). But I am having a hard time figuring out what constitutes a "high titer count" particularly because most of the readings I see are formatted as 1____. How do I translate a decimal reading into a 1_____ ?

Here are my HHV6 results:
Herpesvirus-6, IgG AB (3): (Positive) Result: 1:80 Reference: < 1:80

I am confused about this reading because while it indicates infection (and most people are infected with hhv6) 1:80 does not seem very like a very elevated titer to me. I read else where that IgG > 1:230 was considered an elevated titer.


The Dr. prescribed me Famvir, but if the EBV is the more significantly elevated reading than I wonder if maybe Valtrex would be a better antiviral? Does anyone have experience with either?

Any feed back would be appreciated.
Thank you!
Day

Test for EBV or HHV6 viral DNA in the blood if there is none your issues are not the virus,DNA testing is the one sure way to find out.[/QUOTE]

 

[SK2018]

High "IGG" titres do not indicate active infection ,it indicates a B cell dysfunction and overreaction of the humoral immune system (common in ME CFS) ,a blood DNA test to detect DNA of the pathogens can tell you if there is any active infection or not

Titers fall in the sequence: 1:10 ... 1:20 ... 1:40 ... 1:80 ... 1:160 ... 1:320 ... 1:640 ... 1:1280 ... etc

Or else into the sequence: 1:8 ... 1:16 ... 1:32 ... 1:64 ... 1:128 ... 1:256 ... 1:512 ... 1:1024 ... etc

The higher numbers towards the right of these sequences indicate higher levels of infection. So for example, a result of 1:640 indicates more viral activity than a result of 1:80.

If the titer level of your infection is high enough, then you have an active infection going on, or reactivated infection. If the titer result is slightly lower, then you have the virus in your system, but the infection is not active, or less active. If the titer result is very low, it indicates that you don't have the infection at all (it is not in your body at all).


If you look at this study, it indicates that:

HHV-6 IgG antibody titer of 1:320 or more suggests an active infection.

EBV VCA IgG antibody titer of 1:1280 or more suggests an active infection.



However, I am not too clear on how to convert a 1__ titer reading into a decimal reading and vice versa. I have asked this question before on this forum, but I did not get an answer.

 

[Hip]

High "IGG" titres do not indicate active infection ,it indicates a B cell dysfunction and overreaction of the humoral immune system (common in ME CFS) ,a blood DNA test to detect DNA of the pathogens can tell you if there is any active infection or not

Would you have any references for that? I have not seen any studies suggesting that high IgG in ME/CFS patients is due to an overactive adaptive immune system, although I appreciate that it is a possibility. I am interested in this subject.

My understanding is that in general:

High IgM + Low IgG = New infection.

Low IgM + High IgG = Probable past infection (inactive or cured).

High IgM + High IgG = Reactivated infection.


Source: see slide 5 / 78 in this presentation.

Though EBV testing is a bit more complex, and I don't really understand the ins and outs of it.



In the case of chronic enterovirus infections, according to Dr John Chia, PCR is not sensitive enough, because enteroviruses are quickly cleared from the bloodstream, so the chance of finding enteroviral RNA in the blood is low. See the Enterovirus Foundation (Dr Chia is on the board of directors).

However, in his study looking at chronic enterovirus infections in the stomach tissues of ME/CFS patients, he found enteroviral RNA in 37% of patients, and enterovirus VP1 capsid protein in the stomach tissues of 82% of patients.