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Hepatitis Issues and post-PEP testing
Feb 10, 2011

Dear Doctor McGovern

With my apologies if some of the questions seem to have been asked before but there are some confusions and ambiguities that I am hoping to clarify. My anxiety is very high because my partner and live in a country where comprehensive knowledge and care for these matters is very challenging.

We followed a 4-week course of PEP late last year. 3 and half weeks (24 days) after the end of PEP or 7 and half weeks after the potentially risky incident we had a HIV 1 & 2 Ab/p24 Ag and an HIV-1 RNA, Quant (PCR) done. The HIV Ab and p24 was negative and the RNA PCR was not detected. (The RNA PCR used was COBAS Ampliprep/Taqman HIV by Roche Molecular Systems, Inc.)

We did some follow-up tests for liver functions and my partners liver enzymes (AST and ALT) have been going up. They are now at 94 and 160 respectively. They were at 38 and 66 a month ago and 74 and 111, 6 weeks ago. We are now concerned about Hepatitis issues.

My question are as follows:

1.) How reliable or conclusive is this specific RNA PCR assuming 3 and half weeks after the end of PEP? 2.) Does the p24 help too. 3.) I have seen some information indicating that Hepatitis C co-infection could significantly delay the development of antibodies and I am concerned with the possibility of this happening too. Would such a occurrence also affect a RNA PCR Test or would this kind of test be able to see through this problem and give reliable information irrespective of the simultaneous infection. 4.) Could this be a Hepatitis B flare-up? The PEP medications were Truvada and Stocrin. My partner has HVB anti-bodies but the Doctors here said the labs showed virus was clear.

We intend to follow the official recommendations and get tested again at 3 months and 6 months. In the meantime though our anxiety is nearly debilitating in part because it would be difficult to get comprehensive care where we live and we would have give up work, etc. If there is any clarifications you can give on the questions above, we would be very grateful.

Thank you for all your care and understanding

Response from Dr. McGovern

Your blood tests are very reassuring to date. I agree with your plan of getting additional follow-up to be complete.

I agree with your concern about hepatitis. If I understand correctly, your partner has antibodies against Hepatitis B. I suspect this is related to past immunization. Prior to Truvada, your doctor probably checked a Hepatitis B surface antigen. Since it was probably negative, I would not be expecting a HBV flare.

I am more concerned about hepatitis C quite frankly. I would get a HCV RNA test to see if it is positive. If so, you should be evaluated by a liver specialist for possible treatment. Cure rates in this situation are very high.

If the HCV RNA test is consistent with acute HCV infection, I would get further HIV testing up to 12 months out to be absolutely sure all is well. This is a precaution based on a case report; however, I want to emphasize that late HIV seroconversion is very uncommon....



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