acute HIV/HepC co-infection dynamics
Dec 19, 2004
Dear Doctor McGovern: Thanks to both you and Dr. Dieterich for finding time to help us. I hope you will share your thoughts on this topic. We know that simultaneous acquisition of HIV and Hep C might cause delayed seroconversion, though with testing technologies improving, it is my understanding this is less and less likely. I want to understand what the HIV virus does in the event of delayed seroconversion. Since HIV utilizes the immune system for its own replication, if the immune system is "bewildered" by the number of infections, that replication might be less efficient. Would that cause HIV viremia to remain low as the virus is not being efficiently disseminated. Or would it replicate with abandon, as no antibody response is being mustered. (Bottom line question: If blood to blood contact occurred due to needlestick from HIV/HepC/CMV/EBV etc... infected person, will the standard PCRs for HIV have the same time course for presentation, or will even that be delayed?---which PCR better to use, DNA or RNA for HIV?) Thanks for assist... Needlestuck HCW
Response from Dr. McGovern
There is not much information on your excellent question. However, a couple of things should be said to address the most pressing issue which is followup testing for rapid diagnosis.
In the data on acute hepatitis, almost all patients have abnormal liver function tests. Although the virus goes up first, the liver tests follow at a close second the next week or two. Therefore, if you are concerned about the hepatitis viruses, an easy way to follow this would be increased monitoring of your liver function tests.
If your provider is concerned about lack of antibody responses, you can also have testing for virus itself. This can be done for HIV and HCV.
I suspect that infection with both viruses at once would be cause for concern because there would be more immune activation of lymphocytes and these are the type of cells which HIV preferentially attacks. Dr. McGovern
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