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HIV-Hep coinfection: test results definitive?
Jun 8, 2008

Thanks so much for the personal time that you continue to dedicate to answering questions through the forum.

In a potential case of HIV-Hepatitis coinfection (either HBV and/or HCV), and where the individual has shown both acute and then chronic Hepatitis symptoms, how definitive would you assess the following results to be:

HIV: negative antibody tests at 3, 9 and 13 weeks plus negative HIV RNA PCR at 16 weeks.

HBV: surface antibody (HBsAg) not detected at 9 and 13 weeks (all other antibody tests were undetected).

HCV: antibody not detected at 9 weeks and HCV RNA PCR tests negative at 9 and 13 weeks.

A couple of additional questions:

- is there any possibility that Hepatitis Delta (HDV) might impact any of these test results? (i.e. viral suppression). Despite all of the 'woo hoo' test result news listed above, I have shown a low lymphocyte count (and CD4 count of 484) at 15 weeks....plus I continue to get abdominal pain and other chronic Hepatitis symptoms.

And finally...can you give your honest view on the outlook for HIV/HBV/HCV triple infected patients infected during 2008. Do we believe that the antiviral treatments for HBV, and exciting protease inhibitors for HCV will significantly improve the outlook for triple infected patients?

Response from Dr. McGovern

Wow - lots of good questions.

1. First of all, most patients who get hepatitis are actually asymptomatic - eg, they have no symptoms. If they do have symptoms, they could be as non-specific as fatigue and loss of appetite.

2. You don't mention the nature of the exposure, but most testing for HIV goes out to six months. HBsAg is usually positive by 10 weeks. HCV antibody is usually positive in the majority of patients by 12 weeks although the testing is usually carried out at six months also. However, all of your results are very reassuring and will most likely hold over time.

3. I wouldn't consider delta without having HBsAg.

4. Yes, I do believe that the future is going to be bright for HCV and HBV therapeutics.



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