One of the most common questions I get is about testing for reactivated EBV. Reading an EBV test is confusing! Making sense of all the antibody markers and different result combinations can be difficult.
However, getting EBV labs done is an important step in the process so you know what you’re dealing with. I also hear that this seems to be an obstacle for many of you as your doctors won’t order the tests, don’t know what to order or don’t know how to interpret them.
In this blog I’ll cover exactly which antibodies to order, how to order the labs yourself, and how to interpret the results. I’ll include a summary chart that you can use as a quick reference.
How To Order Your Own EBV Labs
You’re probably used to being your own health advocate. The good news is that you can order EBV labs yourself. There are many websites where you can place your order, pay for them and then find a nearby lab to do the blood draw. Prices vary by lab but range from $200 - $300. Some websites will also let you use your FSA or HSA to pay for them.
A few options include:
Walk-In Labs:
UltaLabs - EBV Comprehensive Panel
One issue I often see is that many people only get a few of the antibody tests. This can lead to some confusion about whether someone has a past infection or a current active one. I recommend ordering the following tests each time you check your levels as you go through treatment.
A full EBV panel includes:
Viral capsid antigen IgM (VCA IgM) - present very early in an initial infection, then usually becomes negative
Viral capsid antigen IgG (VCA IgG) - present early but peaks after IgM and then remains for life
Early antigen IgG (EA IgG) - peaks early in infection, then goes away in 3-6 months, can come back during reactivation
Nuclear antigen IgG (EBNA IgG) - peaks months into an infection after VCA IgM and IgG, then remains for life
When To Test Total Immunoglobulins
Another test to consider would be testing for your total levels of immunoglobulins including IgM and IgG. Many people with reactivated EBV are immunocompromised so this test will check that you have adequate levels of the markers we’re testing for in the EBV panel. If you don’t have enough IgM or IgG in the first place, your labs might incorrectly show negative values.
Taking A Closer Look At The Antibodies
To fully understand EBV testing and results it might help to understand each antibody better. We’ll go over the main four here.
Viral Capsid Antigen IgM (VCA IgM)
This marker is a sign of active, initial infection. It’s the first one to show up positive and then goes away in about 4-6 weeks. Unless you catch it early in the initial infection, it’s likely to be negative anytime you test. It can be normal to see this marker negative. However, in some people, it does show up positive during reactivation because levels can rise during this time and might be high enough to detect.
Will be positive:
Early on in first infection
During reactivation (for some people)
Can also be false positive due to cross reactions from other recent infections
Will be negative:
During reactivation (for most people)
Most of the time, for most people
Viral Capsid Antigen IgG (VCA IgG)
This shows up somewhat early in acute infection, but does so after VCA IgM. It peaks around 2-4 weeks, then persists for life. It’s normal to see this one positive each time you test. Around 90% of the population will have this antibody but that doesn’t mean you have a reactivated EBV infection. You need more than just this one antibody test to determine that.
Will be positive:
During active initial infection around 2-4 weeks, then persists for life
During reactivated infection
This marker will be positive for nearly everyone
Will be negative:
Very early in an infection, before 2-4 weeks
Nuclear Antigen IgG (EBNA IgG)
This shows up a little later in an initial infection, around 8-12 weeks, then persists for life like VCA IgG. Just like VCA IgG, this marker will be present in most people, but that doesn’t mean you have reactivated EBV. Some people may also not make this antibody or “lose it” in the progression of their illness.
Will be positive:
Later on in the initial infection around 8-12 weeks, then persists for life
Will be negative:
In very early infection before 8-12 weeks
It’s possible to not make this antibody or “lose it”
Early Antigen IgG (EA IgG)
This shows up early, around the same time as VCA IgG, then decreases around 3-6 months. It’s not often ordered when checking for reactivated EBV, but it can rise during reactivation, making it an important marker to test for.
Will be positive:
During initial infection around 4 weeks
During reactivated infection
Can be positive for years in some individuals even without symptoms
Will be negative:
In early infection before 4 weeks
3-6 months after infection
PCR Testing
This test doesn’t measure antibodies, it measures levels of the virus in your blood, called “viral load.” It can be helpful if someone is immunocompromised and antibody tests aren’t reliable. However, it’s most sensitive early in primary infection and may not be very helpful in chronic or reactivated EBV when the virus is no longer hanging out in the bloodstream and has moved into the organs and cells.
Maybe you’ve had this puzzling result of a negative PCR and a positive antibody test. These two tests seem to be contradicting each other. In this case, it had probably been too long and EBV was no longer detectable in the bloodstream, while your antibodies were.
Will be positive:
In early primary infection (before 4 weeks) and is a very sensitive marker for detecting EBV at this time
Will be negative:
Later on in initial infection and during chronic and reactivated infection (even though antibody tests may be positive)
Possible Result Scenarios
There’s a saying to “treat the patient, not the labs”. This just means that labs are useful, but so is how you’re feeling. Even if your labs aren’t “typical” you may still have reactivated EBV. Strongly suspect reactivated EBV if your symptoms started after having another illness (especially Covid-19), you had mononucleosis in the past or your IgG antibodies are very high (2-4 times the reference ranges.)
Summary of EBV Labs and Interpretation
VCA IgM | VCA IgG | Early Ag IgG | Nuclear Ag IgG | Interpretation |
Negative | Negative | Negative | Negative | No infection |
Positive | Positive | Negative | Negative | Early, primary infection |
Negative or Positive | Positive | Positive | Negative | Late phase of primary infection |
Negative | Positive | Negative | Positive | Past infection |
Negative | Positive | Positive | Positive | Reactivation |
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-Dr. Jamie
Resources
Kines, K. (2018). The Epstein-Barr virus solution: The hidden undiagnosed epidemic of chronic fatigue, fibromyalgia, and autoimmune disease - how to heal and regain your life. Holistic Nutrition Press
This website is not intended for the purpose of providing medical advice. All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.
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