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acute hep vs hiv
Mar 14, 2009

Hello. I have had unusual symptoms that even have my doc stumped... starting 2 weeks ago, I would wake with horrible arthritis in my knuckles, wrists, knees, ankles (I've never had any history of this)... by late morning, it would clear... however by early evening, I would have the most intense all over itching from the neck down to the soles of my feet... with very little rash... the itching would go on until I will fall asleep exhausted... then the whole cycle repeats of arthritis in the morning, intense itching in the evening.

ALT was over 1600, AST over 500, liver enlarged and tender, bilirubin at high normal and ALP at high normal.

My doc thought Hep A or B, but I was vaccinated last year... and he though Hep C was unusual to have severe acute stage...

Could this also be acute HIV?

Other info: no fever, some night sweats, 37 yo gay male, protected anal sex (but maybe a tear in a condom?)

Still waiting on HAV, HBV, HCV serology, but doc didn't think it was necessary to test for PCR HIV...

But did get NEG results on syph IGP/IGG and HIV antibody.

Could this be acute HAV or HBV even though vaccinated? Could it be HCV even though this is acute? Could this be acute HIV?


Response from Dr. McGovern

When testing for HCV acute infection, I would recommend that you have testing for HCV RNA as well. This can be positive before the antibody is reactive.

Also would check to be certain that your hepatitis B surface antibody titers are consistent with protection. But, most likely you are protected.

Finally, the severe joint symptoms are somewhat unusual for HCV infection but you obviously have a hepatitis of some etiology - yet to be determined. HIV has been associated occasionally with hepatitis - but the ALT and AST are not near this level of abnormality. I am still suspicious of acute HCV infection due to the level of abnormality of the ALT, which is usually related to one of the viral hepatitis viruses. CMV and EBV can also cause hepatitis, but not usually of this level either.

Immunization for Hep B
my wife and i

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