[Question #9384] Hep C? Coinfection

33 months ago

Hi,

I’m following up in a way to my previous question. Exposure was condom failure while I was bottoming. I was on PrEP during this time, and stopped prep 5 weeks after the encounter as I am not planning any sexual activities outside of main relationship.

Dr Hook had told me the risk was low due to consistent PrEP. I tested 3 weeks after stopping PrEP with an 4th gen test and the test was negative, I know this isn’t conclusive and will test again at 6-8 weeks as Canadian guidelines say.

My main question now is regarding hepatitis C, I know this is rare during sex, but is possible during anal sex. There was bleeding that occurred when I was bottoming, so I assume there was a risk for hepatitis c. I am looking into getting tested for this, it has been 9 weeks since the exposure, would a hep c test be accurate at this point? And would the Truvada have any effect on hep c testing in terms of delays.

Also what caused me to worry is that I read about hep c causing hiv test results to be delayed, is this true? One source says to test after a whole year!

Thank you

H. Hunter Handsfield, MD

33 months ago

Welcome back to the forum, but sorry you found it necessary.

I agree with Dr. Hook: near zero risk for HIV, since you were on PrEP, and although your 3 week test result isn't conclusive, it is fairly reassuring. It is very unlikely your 6-8 week test will be positive.

There should be no concern about possible hepatitis C virus (HCV) infection interfering with your HIV test. That can happen, but is very rare. And anyway, the likelihood of HCV also is low. Anal sex with bleeding does suggest risk for HCV, and I agree you should be tested, but it is very unlikely you were infected. The only anal sexual practices associated with new HCV infection have been especially traumatic ones, like fisting, vigorous use of sex toys, and so on. Further, HCV usually isn't present in semen, or only in low amounts, so penile-anal sex is not the main risk. (This is one of the reasons that sexual transmission of HCV does not occur between males and females -- contrary to what you might assume based on the extensive misinformation online. Transmission in men having sex with men, with traumatic anal practices, is the only proved sexual transmission scenario for this virus.)

For all those reasons, HCV testing makes sense, but you can expect a negative result. The tests are conclusive any time 6 weeks or more after exposure, so you can do it now. I cannot imagine that HCV actually extends the HIV test result as long as a year; I would disregard that report, but anyway this is irrelevant if both your HCV and HIV tests are negative, as expected. And no, Truvada has no effect on HCV or the tests for it.

I hope these comments are helpful. Stay mellow as you await your test results: almost certainly all will be well. Let me know if anything isn't clear-- HHH, MD

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33 months ago

Thank you Doctor for the thorough explanation.

You say that the hiv test delay is rare but possible, I read through the forum and it was mentioned that even if hep c delayed antibodies, 4th gen tests would be accurate due to the antigen, is this true? What about for something like HIV2 which doesn’t have an antigen test?

Let’s assume I test negative antibodies to HCV test next week when I can go test (doctor will probably prescribe another 4th gen hiv test as well, which would be 4 weeks post PrEP), I can assume that test for the HCV is conclusive? There’s information out there that people with HIV can delay HCV antibodies in turn. I think that is for people who are immune compromised due to HIV, so that wouldn’t apply to me right since if anything I would only be in acute stages.

If one was infected by both HCV and HIV at the same time, one or both of them would show up on a test at 6 weeks? There’s no possibility of them both being delayed?

Thank you!

H. Hunter Handsfield, MD

33 months ago

I don't know if testing for HIV2 might be affected by acute HCV infection, but HIV2 is so rare in the US that it's a non issue. (Few in the US have had HIV2 except immigrants from Africa or their regular sex partners.) And obviously irrelevant to you unless you turn out to have HCV, which will not happen.

Let's address your other questions if you happen to test positive for HCV. If your test is negative at 6+ weeks, it will be conclusive. I see no reason to expect both to be delayed.

And I realized I wasn't completely clear on the risks of anal sex and HCV. The risk is not to the anal partner. The data suggest the anal partner's bleeding results in transmission to the partner performing the traumatic anal contact. Your bleeding during receptive anal sex potentially risked HCV for your partner, if you already had it. It does not imply risk for you. Sorry I didn't think to stress this in my reply above. (In the unlikely event you test positive for HCV, it will be your responsibility to inform your partner.)

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32 months ago

Hi Doctor,

I had some more tests done. 4th gen test done at 4 and 5 weeks post pep. And HIV-1/HIV-2 Qualitative RNA at around 5 weeks post-prep (through labcorp). These came back negative. My hep c test at this time (9 and 10 weeks post exposure) was also negative. Hep b came back negative and doctor wants to give me a booster dose as I no longer have immunity. Also, I have been having a rash on my neck, and what feels like random spots of lymph node swelling in some areas of the body since just before the 4 week test after the prep, I assume this is not ARS as the tests would be been positive in that case?

I will do some more 4th gen tests, maybe at 6 weeks and 8 weeks. Can I expect these to be negative? Would it be reasonably conclusive at this point? I will likely also do a test at the 3 month mark as I have read on here that some experts recommend that, would 12 weeks be the same idea instead of the 3 months? Would you expect that to be negative if I test negative on my next tests? I absolutely dread the extra month of anxiety to get the 3 months, but will get through it for conclusive results.

I have been avoiding sex with my long term current partner, I’m hoping it would be safe enough to restart sex with them after my 6-8 week results.

Finally, last question I have been using topical Tretinoin on my face, and topical hydrocortisone 1% on my neck for the rash, I know the hydrocortisone is a steroid, this doesn’t have any immunosuppressant effects or any other effects on HIV right? Same for topical minoxidil 5%, I’ve been wanting to start that but have been waiting until after I do my tests in case there is an interference.

Thank you

H. Hunter Handsfield, MD

32 months ago

It makes no sense for you to "do some more 4th gen tests". BY ITSELF AgAb (4th gen) is conclusive at 6 weeks. But the COMBINATION of negative RNA plus negative AgAb testing is conclusive by 4 weeks. It is already 100% proved you do not have HIV. Same for HCV. Stop wasting your money on any more tests of any kind.

As you already have been told, there are no medications of any kind that have any effect on reliability of the tests you have had, and that includes immunosuppressive drugs like hydrocortisone. With the modern HIV tests, no such "interference" exists, ever.

That concludes this thread. Please note the forum policy against repeated questions on the same topic. Any further ones about this exposure, your concerns about HIV or HCV, and your test results will be deleted without reply and without refund of the posting fee. ASHA does not want to collect fees for repeat questions with obvious answers, and such questions have little educational value for other forum users, one of the forum's main goals. Thank you for your understanding. If you continue to have concerns along these lines, I suggest you go back and carefully re-read the responses on this and your previous thread.

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