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Hepatitis and HIV CoinfectionHepatitis and HIV Coinfection
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HIV+ and suspected HCV infection
Nov 9, 2008

I'm HIV+ and have been pulled off all meds because a routine LFT came back abnormal. I've had twice weekly LFT's since. These are the results since stopping my HIV meds: ALT 540, 394, 445, 422, 419 ALP 197, 157, 156, 154, 164. I'm now waiting for HCV antibody and PCR results to see if I have HCV. I've had 2 possible exposures to HCV, 21 Jan 08 and 9 Aug 08, my last HCV antibody test was on 1 Apr 08 and was negative. Do these numbers and my history suggest HCV to you? My HIV doctors seem quite certain. Are my liver numbers that bad? These figures have been over the last 2/3 weeks, when should they start to come down? I don't drink alcohol or take any other drugs by the way. My exposures were unprotected anal sex (I was the bottom) with a partner now known to have HCV. I had rectal bleeding after sex. Thanks for your time.

Response from Dr. McGovern

Yes, I am quite concerned that you could have a viral hepatitis.

Sexual transmission of Hepatitis B or C is possible. If you are vaccinated against hepatitis B, hopefully your surface antibodies are still protective.

As you know there is no vaccine for hepatitis C so this is a real possibility -- particularly if you had anal sex with trauma. There are several reports of MSM acquiring acute HCV infection in Europe and the US. These outbreaks have been associated with traumatic anal sex and sometimes with other STDs.

I would await your HCV RNA... If positive, I would consider early therapy with Pegylated Interferon and Ribavirin since the cure rates are high in patients with acute HCV infection. I would also check your HCV genotype if your RNA is positive. Be aware that your CD4 count may drop on interferon but your CD4 percentage will stay the same or increase.

If your viral workup is negative, you also need to consider the possibility of drug toxicity. If negative, I would also get an ultrasound.

Best wishes for your complete recovery.

Twinrix after possible exposure to Hep B
Fatty changes in Liver

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