[Question #13040] HIV/HCV coinfection

2 months ago

Hello

4 months ago I had a possible exposure via recieving oral from HIV positive person. I always assumed it was zero risk however iv since read reports that it is possible although rare.

48 hours later I had a lot of HIV specific sypmtoms and feared the worst. But since then I have had the following tests post exposure and all test have been negative.

Gen 4 HIV at 5 days, 5 weeks, 8 weeks, 12 weeks and 16 weeks. Plus iv had early detection PCR RNA at 8 weeks and was also negative.

On the same days above, iv also had HCB antigen and HCV antibody tests and all these were negative also as well as the PCR tests for both HCV and HCV at 8 weeks and they were negative.

I am really struggling as my doctor mentioned I should be fine although falsw negatives can occur for longer period with coinfections.

I thought with my negative tests this would rule out coinfection especially after the window periods but apparently cohabitation of viruses can result in negative Viral load and antibody tests which has knocked me.

1. Is the above statement true about coinfections? My doctor was GP and not a specialist.

2. When can i confidently assume I am free of HIV and HCV?

3. Is there anything I can do or any tests that I can do at 4.5 months now to rule out any of the above?

It just seems at the moment that I have to continue to test and we are just waiting for these to turn positive. Its been a painful 4 months and I just want this torment to end.

H. Hunter Handsfield, MD

2 months ago

Welcome to the forum. I'm happy to help. The bottom line is that you were at little or no risk of HIV; there has never been even a single proved case of HIV transmitted mouth to penis. But even if you had been at risk, your test results prove you were not infected. Given the risk at the time, you have been seriously over tested for HIV and certainly did not need the PCR test. Your negative AgAb (4th generation) blood test at 8 weeks was conclusive. Finally I agree with your doctor's reassurance, but he is wrong about false negative HIV tests. With the modern HIV tests, including the ones you had, this simply does not occur.

1. There has been a lot of online buzz about HCV and HIV tests interfering with one another but this is very rare; could not occur with all the tests you had; and HCV is never transmitted by oral sex. The only proved sexual transmission risk is with traumatic anal sex, with blood exposure.

2. You can confidently know for certain (not just "assume") right now that you have neither HIV nor HCV.

3. There is no need and no point in further testing.

It seems to me that the main problem here is your anxiety, guilt, and perhaps shame over a sexual decision you regret. Deal with those emotions as you need to, but don't confuse them with infection risk. They aren't the same and you do not have HIV.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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2 months ago

Thank you for your response. Its extremely reassuring which is why I have taken a few days to digest and it sounds like i need to try and move on from this.

You are correct that there is some anxiety and guilt over the incident however a lot of this has be

2 months ago

Sorry, i accidentally clicked submit before finishing.

Thank you for your response. Its extremely reassuring which is why I have taken a few days to digest and it sounds like i need to try and move on from this.

You are correct that there is some anxiety and guilt over the incident however a lot of this has been driven by my doctor. I will try and work to let this go which is very hard after you have convinced your brain that you will be positive.

I do have a few follow-up questions if thats ok.

1. When you say online buzz regarding interference between HIV and HCV tests, is that driven by medical journals or analysis or is it mostly just in theory?

2. If by the extremely rare off chance that somebody was delayed in antibody production, would you expect the p24 antigen part of the gen 4 test to be positive? I assume antibodies are what nullifies the antigens so without antibodies then p24 antigen would still persist?

3. Should i have any reluctance at the moment in being intimate with anyone now or would you say i am 100 conclusive and free to have sex again?

Thanks

H. Hunter Handsfield, MD

2 months ago

1. There have been a few isolated case reports of HIV/HCV test interference. But HCV is sexually transmitted far less commonly than sometimes believed. The ONLY sexual transmission risk with any measurable frequency comes from traumatic (i.e. potentially bloody) rectal sexual actives between men. HCV is not transmitted by oral or vaginal sex.Your exposure had no chance of HCV, so dual infection was impossible even if you had acquired HIV. But as for all potentially anxiety producing medical issues, the problem of test interference is an online discussion topic way out of proportion to reality.

2. Yes, this is exactly the reason the AgAb tests are an improvement over standalone antibody tests: they are positive sooner because of p24 antigen. There is never almost a delay in HIV antibody longer than a few weeks, but if that happened it would be expected that p24 would persist in especially large amounts and the test would be positive.

3. You can safely have unprotected sex with anyone you want.

Another fact might reassure you even more. In the 21 years of this and our preceding forum, with thousands of questions about HIV exposures, not one has yet turned out to test positive. You won't be the first. If and when if finally happens, surely it will be from a genuinely high risk exposure and the test results will be typical -- i.e. without false negative or delayed test results.

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