If simultaneous acute HIV/Hep C co-infection is suspected in needlestick, which testing format would you recommend as regards HIV PCR. Would DNA or RNA PCR for HIV be more sensitive/specific if concern was delated seroconversion due to acture co-infection immunoincompetence? Thanks, HCW

In the setting of acute hepatitis C, both testing for hepatitis C antibody and hepatitis C RNA would be prudent. If the hepatitis C antibody is negative and the patient is viremic, then the diagnosis of acute hepatitis C infection can be definitively made. However, in the setting of acute hepatitis C, antibodies can be positive about 60% of the time early in infection.

For acute HIV, the approach would be similar. In very early HIV infection, the antibody will be negative but the patient will be viremic. It is standard to draw an HIV RNA, and the possible simultaneous presence of hepatitis C viremia would not change my mind about that. If the HIV antibody is negative and the patient has a significant level of viremia, then acute HIV infection would be suspected and the HIV antibody will soon become positive.

There are rare instances when HIV DNA is drawn in specialty laboratories, but not in the setting of acute HIV.

Dr. McGovern