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Guidelines may need to be revised or clarified
Jul 27, 2010

Dear Doctor Bob,

I was really hoping for some clarification.

You stated in the archives (yes, I did check them) that,

"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!"

This is very clear - If you don't develop HCV, then HIV testing beyond 3 months in unwarranted.

However, the reason I'm confused by this recommendation is that HIV itself can ALSO delay hepatitis C antibodies from showing up in a HCV test longer than three months (sometimes out to a year) when both illnesses are contracted simultaneously. So how are we supposed to know that we don't have hep C and can rely on our three month HIV test?

I normally would not be too concerned by this, but in addition to HIV symptoms, I'm also exhibiting symptoms that are in line with HCV (i.e. liver pain). This is destroying my life and it just won't quit. I seriously cannot enjoy anything, because these illnesses are always in the back of my mind. I appreciate you help.

Response from Dr. Frascino

Hello,

Nope! The guidelines do not need revision.

You seem to be confused about a test result (detectable levels of hepatitis C antibodies) and an illness (acute hepatitis C infection). Please note the guidelines do not mention hepatitis C antibodies, but rather becoming clinically ill with acute hepatitis C. (This would involve physical symptoms, increases in liver function tests, etc.)

Your fears are unwarranted.

Dr. Bob



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