Dr. McGovern,

I asked the question "I have HIV and Hep C." which you answered on February 18, 2008. To refresh your memory, I was diagnosed with hepatitis C in November of 2007 and my first HCV RNA test came back undetectable. My doctors thought I cleared the virus. Then, I went back for a second test in January of 2008 to see if it was still undetectable. My test came back with a HCV RNA of 5,000 which is very low. I have since switched doctors and my new doctor did another HCV RNA test on March 7, 2008 and it came back undetectable again. I am very confusedhave I cleared the virus?

You will need serial testing to continue to be certain that this is the case. I have seen viremia return after clearance without reexposure, although this is uncommon. If viremia returns, I would expect it to declare itself in the next few months.

I would continue testing you over the next few months to be certain of clearance. You can also have liver function testing (ALT/AST) in months that you don't have HCV testing since most patients will have abnormalities in these tests if HCV rebounds.

Overall it appears that your body is "controlling" the virus. However, HIV infected patients don't usually clear acute HCV so I would advise careful follow-up to be sure.

Remember that if your viremia returns, you will most likely respond extremely well to pegylated interferon and ribavirin therapy, if needed.I would use two drugs in an HIV infected person who has acute HCV unlike in most mono-infected patients, who are usually treated with interferon alone.