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Hepatitis and HIV CoinfectionHepatitis and HIV Coinfection
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I have HIV and Hep C.
Feb 18, 2008

Dr. McGovern,

I was diagnosed with HIV in November of 2006. Then, in November of 2007, I was diagnosed with hepatitis C. My doctor and I are confused of how this may have happened because I do not meet any of the risk factors. I do not do drugs, I dont drink and I am not promiscuous. After testing positive for the hepatitis, my doctor ordered a viral load and geno-pheno test to decide whether treatment would be a viable option. The viral load test came back undetectable (<10 IU/mL) and the geno-pheno test could not be completed because insufficient HCV RNA. My doctor thought I may have cleared the virus but wanted to test my viral load again in twelve weeks to be sure. I just got my test results and now have a HCV detectible viral load of 5,000, which I was told is extremely low.

My HIV viral load has increased a little from 11,000 to 19,000 and my CD4 count is 341 with a high percentage of helper cells. I am not being treated for the HIV because I am asymptomatic and my numbers are not horrible.

Is it possible that I could still clear the hepatitis C without treatment? Is it normal to have an undetectable viral load and then, three months later, have a very low detectable viral load?

Any thoughts you may have would be greatly appreciated

Response from Dr. McGovern

Since you do not have any obvious risk factors, I would at least ask your partner to get tested to be certain that HCV was not transmitted during sex. This is uncommon, but can occur.

The sequence of your tests doesn't make sense to me. If you were HCV positive and this was the beginning of your HCV infection, your first HCV RNA should have been positive also.

I also agree that the first test would have made me think you had cleared the virus. The second test demonstrates a very low RNA level, which makes me wonder if in the first test, virus may have been present, but in even lower numbers. This could have led to an incorrect result, especially if the specimen wasn't processed in a timely manner. RNA degrades quickly and can lead to a false negative test.

Alternatively, perhaps you did clear the virus the first time you were exposed and now you have been exposed again. That is why I would be cautious and examine any potential exposure, including sexual intercourse with a long-term partner.

This is certainly a conundrum. I would certainly follow up with yet another test.

30 Years of HEPB

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