HCV TMA WINDOW PERIOD
May 19, 2007
I am a medical student (I graduate in a few weeks) who was stuck with an HCV+ and HIV viral load negative hollow-bore central line needle ~30 days ago (some graduation present). I have had a 14 day negative HCV/HIV CHIRON TMA QUALITATIVE assay, which is the same kind of test used to test blood donations (of course I did NOT donate to get tested). 21 Day and 31 day tests pending, with follow up TMA at 6, 8 and 12 weeks, AB at 6 mos (this testing series was recommended by an ID attending).
This incident has produced in me a major depressive episode that I am trying to cope with, and I don't even care to be an MD at this point, although I know this is a product of the depression. My Specific Question: What is the window period for Chiron TMA for HCV by which I can be relatively confident in being non-infected, and which I may be confident.
I have done an extensive literature search with conflicting information about PCR or TMA positivity after infection. Several sources say virus is detectable after 1-2 weeks in nearly everyone infected (HEPATOLOGY, Vol. 36, No. 5, Suppl. 1, 2002; JAMA, February 21, 2007Vol 297, No. 7 (Reprinted); Annals of Clinical & Laboratory Science, vol. 32, no. 2, 2002; HEPATOLOGY, Vol. 39, No. 4, 2004), while other papers state that it can take longer (JOURNAL OF VIROLOGY, Nov. 2004, p. 1225212258 see small text about inclusion criteria).
Please provide your opinion on Negative Predictive Values and how much I may allay my concern at each TMA testing interval. This testing scheme is both to stem my worsening major depression with an earlier answer and provide for much earlier treatment. The literature is conflicting on this answer.
Also, in the unfortunate occurance of a positive result, what dose of weekly PEG-INF do your recommend to correspond to the daily non-pegalated inf does used in the following study: N Engl J Med, Vol. 345, No. 20, pg 1452. I am sure some other individuals will find this answer informative.
Response from Dr. McGovern
Your testing protocol is so complex, that I myself would not have ordered this. Sometimes knowledge of medicine can be difficult when you yourself become a patient. Yes there are varying windows reported, because there are relatively few data regarding acute HCV infection and I believe that the host response is very important in the presentation of disease. Your testing so far is very reassuring and I am confident that you will eventually put this incident behind you. This is one aspect of medicine that is sometimes hard to cope with. However, always seeking professional guidance at these times is critically important.
The AASLD guidelines (aasld.org) recommend consideration of pegylated interferon for acute hepatitis C and consideration of ribavirin on a case by case basis. Since your followup has been so close and complete, if you should present with viremia, I would only use pegylated interferon.
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