[Question #6985] Follow Up on [Question #6954] HIV TESTING

11 months ago
Hi , 
I just wanted to follow up on the subject above. I forgot to mention that I did HEP C RNA 22 days post exposure and came back as negative. I also did on this past Monday which is 22 weeks post exposure HIV using 4th generation and came back negative. 
I have been reading online lately relating to HIV/HEP C co infection and how the HIV window period may be delayed to 6 month and even 1 year. There was a case documented in 1990 which says that a nurse was exposed to a needle stick injury and she got HIV positive around 9 month later and HCV positive 11 month later. Now relating to my case, 
1. Is the HCV RNA taken 22 days post exposure conclusive even though I took 3 day PEP? CDC says window period for RNA HEP C is 2-3 weeks. I tested again for HCV RNA yesterday but results not yet out. 
2. If answer to question 1 above (conclusive - meaning I don't have HEP C), then I should disregard 6 month  and 1 year HIV window period above and that my HIV results are conclusive???
3. In your opinion, why does Hep C/HIV delay HIV seroconversion. Is it because of HEP C treatment? HIV treatment? Whats the interaction between both infections? I know each has different protein type e.g. p24 protein so why HIV testing is delayed even though HIV tests looking specifically for those proteins e..g p24. 
Thanks 
Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago
Welcome back to our forum although I am sorry you felt the need. On this occasion I will be responding to your questions. In preparing to answer these questions I reviewed your interaction with Dr. Handsfield two weeks ago and I agree with all he said.  Your test results already prove that you were not infected with either HIV or hepatitis see and no further testing is needed. I will now go on to address you were specific questions.

1.  I am confident that the tests for hepatitis C that you took yesterday will also be negative. Further testing was unnecessary. The combination of having antibodies to hepatitis C and a negative hepatitis C PCR proves that you have had the infection, it is resolved, and you were not at risk for further infection.

2.  Correct, further testing for HIV related to the exposure you described is entirely unnecessary. Lingering recommendations for late testing of the sort  you describe is a combination of Internet-fueled misinformation, and out of date recommendations made before currently available tests were in use.

3.  The sort of delays in hepatitis C seroconversion you describe our rare, if they happen at all. Such has certainly not been my experience. I have no good explanation and find that no such credible explanations for this phenomenon if it even occurs in the medical literature.

A final comment. You described earlier your considerable anxiety related to the exposure which set off this bout of testing. I can understand the anxiety and suspect that to learn more you have been seeking information on the Internet. If so, the Internet is not your friend here and in fact will more likely mislead and misinform you than help.  I urge you to stay off the Internet. All too much of what you will find there is out of date, taken out of context, misinterpreted, or urban myth. It is extraordinarily difficult to determine fact from fiction Among the statements found on the Internet. I hope that my comments, perspective in the information I have provided are helpful.  EWH
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11 months ago
Thank you doctor for your reply. 
I just have few more questions regarding HEP A and HEP B. I tested for both of them 22 days post exposure and the results are below. 

IMMUNE STATUS/PREVIOUS EXPOSURE - HEPATITIS A HAV TOTAL ANTIBODY         POS      POS

As of January 13, 2020, please note change in methodology. The presence of lgG antibodies to HAV indicates previous exposure or vaccinat ion, and immunity to hepatitis A.


IMMUNE STATUS/PREVIOUS EXPOSURE - HEPATITIS B

 

HBs ANT IBODY                                     POS      POS

773  U/L

A positive test indicates previous exposure to hepatitis B by infection or vaccine. Anti-HBs can occasionally be present in the carrier state. In all anti-HBs positive patients in whom natural infect ion is likely to have occurredit is advisable to test for the presence of

HBsAg at least once to rule out chronic carrier status.

A value of 10 U/L or greater is consistent with immunity.
So, 
1. I am not understanding HEP A results. I know I am immune to HEP A due to presence of IGG but these results do not say anything about HEP A IgM which is the one I am in more interested. Did I catch HEP A from this exposure or no? Am I immune to HEP A? 
2. Do I have HEP B? Did I catch HEP B from this expousue? 
3. Do I need further HEP A or B testing? 
4. Do Any of HEP A/HEP B immunity or active infection  affect HIV Results? 
Thanks 

11 months ago
By the way, I tested for Hepatitis B surface antigen on Jan 15 which is 18 days post exposure / 14 days post PEP and came back as negative. 
11 months ago
Also, I would like to understand the meaning of the word co-infection.  I understand that co-infection is like getting HIV and HEP C simultaneously or getting HEP A and HEP B simultaneously from the same exposure. 

1. Do both infections have to be active to be considered co-infection? Can, for example active HIV (say from exposure A) and past/cured HEP C (say from exposure b) considered co-infection or no? I am just trying to understand if the HCV antibodies and negative HCV RNA  considered a  co-infection  with HIV(if I were to get it).  

2. I have read on CDC that even though I have HCV antibodies, I can still get reinfected. Dr . Handsfield says otherwise. Can you please explain? 
Thanks and I hope these are my last questions. 
Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago
Before I address your questions, please let me urge you to not worry about sexually acquired hepatitis A or c.  Both are rarely sexually acquired.  Hepatitis A is spread as the result of contact with the feces of an infected partner.  Thus in situations in which there is anal sex followed by oral sex, or analingus it may be transmitted.  As for hepatitis Cit is almost never transmitted sexually.  On those rare occasions when it is it occurs during sex it occurs during receptive rectal sex with an infected partner.   Even then, it is quite rare.  I think you are worrying unnecessarily.  Now my replies:

1.  Your result show you have either had or are immune to hepatitis A.  You cannot get it again.  You could be immune either because you had the vaccine or because you had the infection(many people with hepatitis A get it and get over it without symptoms.  No IgM test is needed.

2.  Your tests show that you are immune to hepatitis B.  This too could be either because of receipt of the vaccine or having had the infection and recovered.  No other testing is needed..

3.  You do not need ANY further testing for hepatitis A or B.

4.  As you were told in the past, your hepatitis test results - all of them - will not affect your HIV test results at all.

5. The term co-infection means that both infections are present simultaneously.  It says nothing about when they were gotten, just that both infections are present and active at the same time.

6.  Both are right.  Prior hepatitis C makes it unlikely that you will be re-infected.  Persons who are cured of hepatitis C using medications have been shown to get re-infected but when you get over it without treatment you are likely to be immune.

Hope this helps.  As I said above, you are worrying unnecessarily.  You cannot get hepatitis a, B, or C again. EWH


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11 months ago
Ok. So co infection would mean having two infections present and active at the same time. In my case, I have zero infections present and active (neither hep a,b, c or hiv) given all the prior testing done ..got it. I will now try to move on with my life and try to forget the past even though this is really hard. How can you control your thinking or memory????? It's impossible. You will think/remember about/the past ,its inevitable.  


Edward W. Hook M.D.
Edward W. Hook M.D.
11 months ago
Your summary is correct. Your tests clearly show that there are no active infections present. You can move forward without concern. I urge you to believe the science. If you are having trouble doing that, this is not a matter related to testing or infection but a matter related to your anxiety and guilt. These issues are best addressed through working with a counselor or mental health professional.

I hope that my comments and the explanations provided have been helpful. As per for guidelines, this thread will now be closed. Take care. EWH
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