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Hepatitis and HIV CoinfectionHepatitis and HIV Coinfection
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is this acute or chronic hep-c
Apr 2, 2007

I am a health care worker.Back in 1992 I had some mild increase in LFT ALT 60 hepatitis-c antibody was negative they came down to normal this happend again in 1995 again hep-c antibody was negative at that time also,and in May 2005 hep-c negative LFT ALT 55.In feb 2006 I was exposed to blood. In april my LFT were over 1000 hep-c was 0.3 s/co two weeks later hep-c was 1.3,Smooth muscle antibody was 61,1.0 million virus were found.HIV antibody was negative, hiv DNA proviral negative, CD-4 789.One month later hep-c antibody was 45.Viral load was 280,000 hep-b surface antibody was 400.Liver biopsy done that same week(subacute hepatitis no fibrosis no cirrhosis but there was some fatty liver ) My GI tells me that this is a chronic hepatitis-c and that the LFT were caused by some lipid meds. (1)-If this is chronic (maybe the smooth antibody is telling them this is chronic)why is it that I never had a positive hep-c antibody in the past I am not on dialysis my HIV was negative CD-4 normal I do not understand please help?. (2)I had an HIV antibodys and DNA proviral done at the time of diagnosis both negative.I also had HIV 1/2 antibodys done 7.5 months after the diagnosis I have read that If you were exposed to HIV and HEP-C at the same time that It may delay HIV antibody production.Should I retest and when? Please explaine this to me it makes no sence I have not sleeped in weeks.Thank you for your time and understanding.

Response from Dr. McGovern

For health care workers, needlestick injuries with exposure to blood can lead to acute hepatitis C. I believe that is what happened to you.

1. Your liver function tests in the past were only modestly abnormal and that was probably due to some degree of fatty liver that you have had chronically. Fatty liver can develop from obesity, diabetes, or high cholesterol or triglycerides. 2. However, in April your liver function tests were extremely high consistent with an acute hepatitis. Your Hepatitis C antibody in the past was negative and now it became positive and your hepatitis C RNA was elevated very high as well. This is a "definitive" case of acute hepatitis C. You may want to ask your physician why he thinks it is the lipid medications; there may be something I am missing here, but on the surface, it sounds like acute hepatitis C. This is important since you are a health care worker and need to have the correct documentation in your record. A second opinion might be helpful as well if you are still confused after further consultation. 3. In acute hepatitis C, I follow serial HCV RNA levels to see if the patient resolves infection on their own. You should have another HCV RNA test to see if this occurred with you since your second viral load was much lower than the first. If the virus doesn't clear on its own, I start early treatment since the response rates are excellent. If I identify a patient within 12 to 16 weeks of presentation, I use pegylated interferon alone; if the patient is identified further out, I usually consider pegylated interferon with ribavirin. Further information and guidelines about the treatment of acute hepatitis C are evolving since there is a growing literature about this infection. 4. I think your HIV antibody is reassuring in this situation, particularly the one that is more than 7 months out. Best regards.


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