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acquiring HIV and HCV simultaneously
Jan 15, 2012

Hello Dr.McGovern, 8 months ago i had sex with CSW, my exposure was receiving unprotected oral,protected vaginal and also i had fresh burn on the back side of my finger which cause non-intact skin but i didnt finger her. i have been tested for HIV and HCV after 3,7 months with antibodies test the result were NEGATIVE. my concern is about getting HIV and HCV simultaneously," the New England Journal of Medicine in 1997 reported a patient where HIV was detected between 8 and 9 1/2 months after exposure, and seroconversion to HCV occurred between 9 1/2 and 13 1/2 months after exposure."

my questions: 1-you have mentioned that if one develop acute HCV,then he should consider testing after 12 months for HIV,but in the health worker case they detect the HIV first then the HCV. then how could i know that i dont have acute HCV my test was negative after 7 months not after 13 1/2 months? do i need to get PCR HIV and PCR HCV to be sure? please help me

Response from Dr. McGovern

I hope that this will be the last discussion of this case which was reported in 1997. It is important to point out that no other cases like it have been reported over the past 15 years. Thus the one case remains unexplained and should NOT guide testing for the millions of people who need evaluation for exposure to HIV or HCV.

The case is also different than any other because of a long incubation time for HCV, HIV and the fulminant liver death that followed. There is nothing else like this case anywhere that I have read. Thus, it does not help provide guidance for testing for other persons.

LFTs in this patient were not followed serially and were only tested when she presented for acute hepatitis illness which preceded her diagnosis of HIV. Since LFTs become abnormal AFTER HCV viremia, this patient probably had HCV RNA in her blood at earlier time points that were just not measured.

We know that the current testing recommendations are accurate in the vast majority of patients. In fact, I have taken care of one of the largest cohorts of acute HCV patients and will tell you that most persons are HCV positive by 3 months and a small handful are positive by six months.

I would be reassured that you are truly negative for either infection. No further testing is required.

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