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Dr. Rob, your input please? (HEPATITIS C AND DELAYED HIV SEROCONVERSION)
Mar 29, 2009

Dr. Bob, I have a question about HIV and Hepatitis C coinfection. I am finding conflicting information on the internet regarding whether coinfection would delay HIV seroconversion. Several sites and articles are stating that it would, but they all cite a 1997 journal article about health care workers with delayed seroconversion. I wasnt sure if other factors may have contributed to late seroconversion in these health care workers (such as PEP). Further, since this article is rather old, I was wondering if the newer tests would pick up HIV antibodies regardless of HCV coinfection. I am wondering how long after exposure do I need to wait in order for my test to provide a conclusive antibody result and rule out HIV infection. My exposure is that i have been involved in unprotected sex one time with a unknown partner. Later i came to know that the partner was with a promiscous guy(who sleeps around with prostitutes) before me. I have got tested after 3 months after the exposure and the HIV antibody test result is negative. Can i forget about this and move on? or Do i still need testing?

I have also read in the medhelp archives that Dr. HHH and Dr. Edward Hook of medhelp say that the HIV/HCV coinfection has no effect on the window period of HIV. Also what is meant by a coinfection, should the person be exposed to both the virus at the same time or same exposure? or does that mean they have already one virus and is exposed to the other one? I am promising donation. Dr. Bob i am so tired to read all the information on the internet about this topic. I am very scared. Also does any type of Hepatitis i mean Hepatitis A, B or C coinfection with HIV delays the window period or is it only Hep C with HIV coinfection? Your comment on this will help me a lot. Thanks for your precious time. Please answer.

Response from Dr. Frascino

Hi,

Your worries are unwarranted. (See below.) Yell WOO-HOO and as Tony Soprano says, "Fuhgeddaboutit."

Dr. Bob

curious (SEXUAL TRANSMISSION OF HEPATITIS C)(HEPATITIS C AND DELAYED HIV SEROCONVERSION)Dec 31, 2008

Hey Dr. Frascino,

First off, thanks for everything you do. Your hard work and dedication to all of us who need answers doesnt go unnoticed. You are a great person. I have a couple of questions.

What is your oppinion on hepatitis c as an STD. Ive heard that it's not and I also heard that it is. Ive been tested for HIV 4 times and all the other stds twice out to 8 months after any possible exposure, but my doctor never included Hep C. Is that something that should be a worry from sex or do you feel it's more of a drug injection disease from blood to blood contact?

Also, if someone is infected with multiple viruses at the same time will the body's immune system still be able to make antibodies for each virus in a normal amount of time? Or would they be delayed significantly? If infact I dont have Hep C, do you feel 8 months negative HIV test is conclusive even though i had a positive mono spot test and EBV titers about a month after my possible exposure to someone of unknown status?

And lastly I have more of a scientific question. Why is it that we are not able to cure the HIV virus yet we are able to use current medication to bring someone's viral load from a very high number to undetectable in the blood? How can we kill off so much of the virus but not be able to completely rid it from the body?

Im sure you are a very busy guy but if you could possibly answer me I would greatly appreciate it, if not no love lost. I hope you are having a great holiday season. Stay well.

Oh and how would i go about making a donation?

Response from Dr. Frascino

Hi,

1. I've discussed the sexual transmission of hepatitis C many times in this forum. Check the archives! As an example, I'll reprint below some information form the archives pertaining to this topic.

2. If someone is infected with several viruses simultaneously, the body's immune system will react to each virus individually and simultaneously. The immune system is very capable of multitasking! There has been some concern about hepatitis C and HIV coinfection causing delayed seroconversion. I've discussed this multiple times previously. See below.

3. Regarding a cure for HIV, we have a whole chapter devoted to this topic in the archives. Check it out! Briefly, the reason cure is so difficult is that HIV attaches itself to CD4 cells, which are part of our immune system, the very system that is designed to help us fight off invading germs. The virus is very clever. It actually inserts its genetic material into human cells and uses these cells as virus factories to make more virus, which then infects more immune cells. HIV can also hide in places that drugs can't get to. I'll reprint some information about finding a cure below.

Thanks for your donation to the Robert James Frascino AIDS Foundation (www.concertedeffort.org).

Happy Holidays.

Dr. Bob

I REALLY NEED YOU!!!! (HEPATITIS C AND DELAYED HIV SEROCONVERSION) May 20, 2008

Dr. Bob, I asked you awhile back if HEP C would delay HIV seroconversion.

You said that HEP C would not delay HIV seroconversion! However, Dr. McGovern of the body says that HEP C will delay the HIV window period and that someone who was exposed to both should wait until 6 months to 1 year!!!! Before getting a result!

What's up with that????

Now I know my risk (sharing dollar bill to sniff cocaine) was a low risk incident but what should I do????

I got tested for HEP C at 14 weeks....NEGATIVE!

And HIV at 15 and 17 weeks!!!! NEGATIVE

What should I do???? I think that I am ok and then I hear this stuff!?

Response from Dr. Frascino

Hello,

No, you don't really need me! What you really need is to pay more attention to what both Dr. McGovern and I have told you on multiple occasions: You are HIV negative. I may need to put a restraining order out on you if you continue to ask your same question over and over again in multiple forums. Come on guy! Give it up! Accept the truly wonderful news you're HIV negative and give other worriers a chance to have their concerns addressed, OK?

This is the last time I'm going to go over this information with you, so pay attention! The Centers for Disease Control has published guidelines for health care workers who sustain a significant occupational exposure to a patient coinfected with HIV and hepatitis C viruses. (This is a far cry from snorting coke through a rolled-up Ben Franklin!) The health care worker guidelines for occupational exposure to coinfected patients suggest HIV-antibody testing at baseline, six weeks and twelve weeks after exposure. There is a caveat, however: If, and I must stress this "if," the health care worker develops acute hepatitis C infection, then and only then (I also stress the "then and only then") would additional HIV-antibody testing be recommend. In this case, and only in this case, are HIV tests out to 12 months recommended. Put another way, if the health care worker does not get ill with acute hepatitis C infection, additional tests would not be recommended!

You have tested hepatitis C negative out to 14 weeks. You do not have acute hepatitis C infection. Hence even if you were a health care worker with documented significant exposure to a coinfected patient, you would not need additional HIV testing. I just can't make it any plainer or clearer than that. Those are the facts, plain and simple. How you choose to live with the incontrovertible evidence that you do not have hepatitis C and that you are conclusively HIV negative is now up to you.

So, I'm signing off on this case permanently. If you require additional reassurance, you can either reread my many (too many) responses to your repetitive and ongoing unwarranted worries or you can seek psychological help. Your problem is not virological; it's psychological!

Dr. Bob

Topping and Hep C (SEXUAL TRANSMISSION OF HEPATITIS C, 2008) Oct 13, 2008

Okay so this is my question.... I am an HIV positive gay man, and currently I had unsafe sex with another HIV positive person, both of us are undetectable, but I later found that he also is co-infected with Hep C. During the sex, we didnt have rough sex and I was the top while he bttmd. So know I am really freaking out because I keep looking online and everything that I am reading says that it a very low risk that you can get through sex and that is is more blood to blood contact. Is Hep C the same as HIV in the regaurds that if you are under going treatment it is harder to catch, and being that I am the top is it harder for me to get it and what are the chances that I can be infected aswell... Please help... Thanks

Response from Dr. Frascino

Hello Top Gun,

Hepatitis C is yet another reason barebacking is risky for MSM (men who have sex with men). We have seen an increase in sexually transmitted hepatitis C in MSM. (See below.)

As for hepatitis C-transmission risk, it's not really analogous to HIV. The transmission is primarily blood-to-blood transmission that occurs due to trauma during the sexual activity. I'm not aware of any data that indicates lower hepatitis C viral load decreases transmission risk, but it very well may be true. Your HIV specialist can easily screen you for hepatitis C. I urge you to reconsider your decision to bareback. Contracting an STD can have very negative consequences on your HIV disease.

Good luck.

Dr. Bob

Accidental Spit in Eye (Hep C) (HEPATITIS C TRANSMISSION) Aug 26, 2008

I have the same question as asked in "blood tainted saliva in eye" asked by another visitor, but my question is concerning Hepatitis C? While talking in a session, a client of mine (I'm a counselor) with that dx in her chart (at some pt), accidentally let a small amount of spit out which hit my eye. What are the chances of Hepatitis C transmission that way

Response from Dr. Frascino

Hi,

Your risk of acquiring hepatitis C from getting a "small amount of spit" in your eye is nonexistent. I'll reprint some information about hepatitis C transmission below.

Dr. Bob

Hepatitis C Transmission

HCV is mainly transmitted when infected blood from one person directly enters another person's bloodstream. HCV has been detected in semen and vaginal fluid, so genital fluids may be infectious. Saliva and tears are not.

HCV, like HIV, cannot be transmitted by touching, kissing, hugging, sharing eating utensils, or drinking from the same glass. However, unlike HIV, which dies in less than a minute outside the body, HCV survives and is infectious in dried blood for days or even weeks. People can become infected by sharing items that contain only tiny traces of dried blood.

HCV can be transmitted through:

injecting drugs using shared syringes and/or spoons, caps, and other cookers; water; filters; and ties that may have been used by someone else;

tattooing or piercing using unsterilized needles, contaminated ink, or inkwells;

needlestick accidents (a problem for health care workers);

medical or dental procedures with unsterilized equipment, including kidney dialysis (rare);

sharing items that may contain blood, such as razors, toothbrushes, and manicuring equipment; and

unprotected sex with someone who has HCV.

Hepatitis C can also be transmitted from a pregnant woman to her fetus in the womb or to an infant during labor and delivery.

Before thorough screening of the blood supply began in the early 1990s, some people received blood or blood products containing HCV. Since then, infection control procedures have virtually eliminated the risk in the United States and Western Europe.

However, up to 90% of people with hemophilia were infected with HIV and HCV after being treated with unscreened clotting factors; screening and viral inactivation procedures were introduced in the late 1980s.

In some countries, infections still occur from blood transfusions because blood is not screened. Unsafe medical procedures, such as using unsterilized equipment to vaccinate people, continue to spread HIV and hepatitis C in many parts of the world.

Hepatitis C and Injection Drug Use Worldwide, most HCV infections are attributable to injection drug use. This happens when people share injection equipment, including syringes, cookers, possibly cottons, and other injection paraphernalia.

Hepatitis C is a smaller, more durable virus than HIV. As discussed above, the hepatitis C virus can live in syringes and other objects for days or weeks. This is why it's so important to talk to people you get high with about how to make sure you're getting high safely, and in a way that protects everyone.

Cleaning syringes with bleach reduces the risk for HIV transmission but may be less effective against hepatitis C. If you're getting high, use a new set each time you inject. If you're injecting drugs with other people, mark your equipment and be sure that everyone has his/her own spoon or cooker. Using clean needles and your own works each time you inject stops both HIV and HCV transmission.

What About Hepatitis C in Drug Users Who Don't Inject? "I also worry about sharing a rolled-up note when I do coke -- but it doesn't stop me from doing it or my friends from being willing to share. I guess this all comes down to individuals agreeing to own and share risks that they feel to be acceptable. These risks feel okay most but not all of the time."

Hepatitis C is more common among non-injection drug users than among the general population. Researchers are not sure why. Since HCV is so common among IDUs, most drug users -- whether they inject or not -- know people who have HCV.

It may be possible to get HCV from sharing straws or rolled dollar bills for snorting drugs, and possibly from sharing crack pipes. Use your own bills and straws, and if you're smoking crack or heroin, use a stem to protect yourself.

HIV, HCV and Sex Sexual Transmission of HIV

Worldwide, sexual transmission accounts for the majority of new HIV infections each year. The risk of sexual transmission is greatly reduced by using condoms during sex.

The ways that HIV is transmitted are well understood. HIV is present in blood, semen, vaginal fluid, and breast milk.

We also know that different sexual acts carry different risk factors. For example, mutual masturbation and body rubbing are zero risk, and oral sex is very low risk. On the other hand, anal or vaginal sex without a condom is high risk. A high viral load in the HIV-positive partner increases the risk for infection, and a low or undetectable viral load will reduce the risk.

An HIV-positive person with untreated STDs (such as herpes, gonorrhea, and syphilis), is more likely to transmit HIV. This is because STDs increase the amount of HIV virus in genital fluids and make the HIV-positive partner more infectious. Similarly, an HIV-negative partner with untreated STDs is more vulnerable to HIV infection.

Sexual Transmission of HCV

The risk for sexually transmitted HCV is very low in monogamous, HIV-negative, heterosexual couples in which one partner has HCV. One study following almost 900 heterosexual monogamous couples did not report any HCV infections over ten years of follow-up. These couples did not use condoms, but also did not have anal sex or sex during menstruation. Presumably, the uninfected partner in these couples may have had less exposure to blood, and therefore less chance of catching HCV during sex.

The risk for sexually transmitted HCV is higher for HIV-positive gay men and is probably also higher for men or women who have numerous partners and/or lots of anal or vaginal sex without condoms.

HCV is usually contracted when infected blood from one person enters another person's body. Although the hepatitis C virus has been found in semen and vaginal fluid, it is unclear whether and to what extent these fluids are infectious.

Sex is riskier if it involves exposure to blood. This could include longer and more energetic sex, anal sex, fisting, sex with a woman during menstruation, and group sex. Condoms can reduce these risks. Latex gloves can reduce exposure to blood during fisting.

HIV-Positive Gay Men In the United Kingdom, more than 300 cases of sexually transmitted HCV infection have been reported in HIV-positive gay men. A similar link between HCV sexual transmission and HIV-positive gay men has been reported in some other European and US cities.

So far, new cases of HCV sexual transmission in HIV-negative gay men are not being reported nearly as often. This suggests that HIV plays an important role.

Some studies have reported associations between HCV transmission and the following risk factors among gay men:

anal intercourse without condoms;

"heavier" sex, longer periods of sex, fisting, and sharing sex toys;

sex with a higher number of partners;

group sex;

use of some recreational drugs that lower inhibitions and may make condom use less likely;

infection with other sexually transmitted diseases, especially syphilis; and

meeting partners online.

We can speculate about each of these points, but there is still a lack of clear information about why HIV-positive gay men seem more likely than HIV-negative gay men to acquire HCV through sexual contact.

Crystal Meth, Ecstasy, Cocaine and HCV Infection Although sex seems to be the route of HCV infection among the HIV-positive gay men discussed above, taking drugs in this situation can increase the risk, even if the drugs are not injected. Drugs like ecstasy, coke, and crystal meth, all of which can make people less careful than usual, are frequently found at parties where there is group sex. Under these circumstances, the desire to dispense with condoms may be high.



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